Salivary glands
Epithelial / myoepithelial tumors
Acinic cell carcinoma

Author: Fatima Aly, M.D. (see Authors page)

Revised: 26 May 2017, last major update August 2011

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Acinic cell carcinoma [title] salivary

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Cite this page: Acinic cell carcinoma. website. Accessed January 23rd, 2018.
Definition / general
  • 1 - 3% of all salivary gland tumors; 3% of all parotid salivary gland tumors
  • #2 childhood salivary gland malignancy after mucoepidermoid carcinoma
  • Usually parotid and minor salivary glands, also parotid lymph nodes
  • 10 - 15% metastasize (usually to local lymph nodes), 10 - 30% recur (may be due to inadequate excision)
  • 80 - 90% recur if incompletely excised
  • 5 year survival 90%, 20 year survival 60%
  • Less aggressive in minor salivary glands
Poor prognostic factors
  • High stage, pain or fixation, gross invasion, desmoplasia, anaplasia or dedifferentiated component, increased mitotic figures, necrosis, neural invasion, incomplete resection, large size, involvement of deep lobe of parotid, multinodularity
Case reports
Gross description
  • Encapsulated, tanish gray, firm to soft, solid / cystic; usually < 3 cm
  • 3% bilateral or multicentric
Microscopic (histologic) description
  • At scanning power, basophillia and prominent lymphoid infiltrate should raise suspicion of acinic cell carcinoma
  • Tumor shows multidirectional differentiation towards acinar, ductal as well as myoepithelial elements
  • Some tumor cells must demonstrate differentiation towards acinar cells
  • Variable patterns: solid, microcystic, papillary cystic (associated with hemorrhage), follicular
  • Variable cell types: uniform acinar (serous) type cells with basophilic granular cytoplasm, clear cells (hypernephroid pattern, contains glycogen or mucin), vacuolated, intercalated duct, nonspecific glandular cells (smaller, syncytial)
  • Few mitotic figures
  • May have prominent lymphoid follicles at periphery (lymphoid stroma), psammoma bodie
Microscopic (histologic) images

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Case of the Week #355

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Papillary fronds with hobnail cells and vacuolated cells

Microcystic and solid
patterns in tumors from
father and daughter

Figure 3A-tumor (left) and normal salivary gland (right)

Various images

D: H&E; E: CK7; F: CK20

Dedifferentiated tumor

Fig 1: dedifferentiated parotid tumor with some classic areas
Fig 2: mitotic figures and necrosis
Fig 3: differentiated areas with basophilic cytoplasm and vesicular nuclei
Fig 4: PAS+ diastase resistant granules

Virtual slides

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Acinic cell carcinoma

Cytology images

Images hosted on PathOut server:

Case of the Week #355

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Acinar-like cells but with
larger nuclei, no ducts, no
fibrofatty stroma and no
"bunch of grades" architecture

Positive stains
  • Keratin, alpha-1-antichymotrypsin, alpha amylase; also vasoactive intestinal polypeptide, myoepithelial markers, granules are PAS+ diastase resistant
  • May have focal neuroendocrine staining
Electron microscopy description
  • Multiple round, electron flocculent material with variable granule density (dependent on fixation), cytoplasmic secretory granules
Differential diagnosis
  • Normal parotid gland: tumors lack striated and interlobular ducts, lack lobular architecture
  • Thyroid carcinoma