Acinic Cell Carcinoma

What is it?

Acinic cell carcinoma is a salivary tumour consisting of cells similar to the serous cells of salivary glands. Histologically, this rare neoplasm has a lattice-like appearance secondary to fluid collection, but a variety of forms have been described. Calcification may also be a prominent feature.

Clinical Features

Clinically, these malignancies may simulate pleomorphic adenomas, presenting as a single nodular mass over a long period of time. The vast majority present between the 3rd and 6th decade of life and are found in the parotid gland. The prevalence is higher amongst females by 2:1. These lesions may be painful, usually upon palpation, however; facial nerve palsies are rare.

Investigations

Physical exam including:

• Palpate the glands
  • Use bimanual palpation in the floor of the mouth
• Imaging
  • CT scan or MRI
• Fine needle aspiration biopsy

Controversy exists over management of acinic cell carcinomas because it is known to recur 1 to 50 years after treatment. Many favour total parotidectomy with resection of involved nerve and immediate repair. Radical neck dissection need only be performed if cervical nodes are involved.

Radiation is classically ineffective for this disease, however should be used for unresectable disease as response does occasionally occur.

The five-year survival has been reported between 47% and 90% while the 25-year survival is 50%.

1. Granick M., Hanna III D., Management of Salivary Gland Lesions. Williams & Wilkins, Baltimore, 1992.
2. Thackray A.C., Sobin L.H., International Histological Classification of Tumours No.7: Histological Typing of Salivary Gland Tumours. World Health Organization, Geneva, 1972.
3. Rice D., Surgery of the Salivary Glands. B.C. Decker Inc., Toronto, 1982.