You answered: Acinic cell carcinoma

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CYTOPATHOLOGY:

• This FNA specimen shows loosely cohesive, atypical serous acinic cells without ductal cells.
• The nuclei are oval, bland, and eccentric, with mild variation in nuclear size. Nucleoli are observed.
• The cytoplasm is abundant and granular.
• These findings are consistent with an acinic cell carcinoma.

DISCUSSION:

• The biopsy reveals acinic cell carcinoma. The neoplastic cells have abundant, granular cytoplasm and fairly bland and uniform nuclei.
• Acinic cell carcinoma is a rare neoplasm of low grade malignancy, and is found most often in the parotid, and most commonly in women in their 40's.
• The cytoplasm contains mucopolysaccharide which is positive with PAS/diastase, and mucicarmine negative.
• The differential diagnosis might include Warthin's tumor, mucoepidermoid carcinoma, or normal salivary gland tissue.
• The oncocytes of Warthin's tumor have much denser cytoplasm with finer PAS/D-negative mitochondrial granules, and a background of lymphocytes.
• Mucoepidermoid carcinoma is comprised of a more pleomorphic cell population and is usually mucicarmine-positive.
• Normal salivary gland tissue contains acini in tight, cohesive ball-like fragments and normal ductal cells.

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REFERENCES:

Bibbo, Marluce. Comprehensive Cytopathology. Philadelphia: WB Saunders Company, 1991; 636-639.

Demay, Richard M. The Art and Science of Cytopathology. Chicago: ASCP Press; 1996; 670-680.

Kini, Sudha R. Color Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytopathology. Baltimore: Williams and Wilkins, 1999; 316.