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Case 09

View the images and select the correct diagnosis from the list below.

A parotid pickle

FNA of the right parotid from a 45-year-old woman:

 

 

 

 

Select the correct diagnosis:

You answered: Warthin's tumour
Sorry, that is INCORRECT

The correct diagnosis is: Acinic cell carcinoma

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 40s.
  • 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.

BACK TO IMAGES



HISTOLOGY



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.

You answered: Mucoepidermoid carcinoma
Sorry, that is INCORRECT

The correct diagnosis is: Acinic cell carcinoma

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 40s.
  • 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.

BACK TO IMAGES



HISTOLOGY



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.

You answered: Acinic cell carcinoma
That is CORRECT!

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 40s.
  • 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.

BACK TO IMAGES



HISTOLOGY



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.

You answered: Normal salivary gland tissue
Sorry, that is INCORRECT

The correct diagnosis is: Acinic cell carcinoma

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 40s.
  • 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.

BACK TO IMAGES



HISTOLOGY



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.

From the Cytopathology files of the BC Cancer Agency
Submitted by: Pauline Lee, B.Sc., cytotechnology student and Tom Thomson, MD
SOURCE: Case 09 ( )
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