Abstract
Distant metastasis of salivary gland neoplasms is a rare occurrence. Generally, high-grade salivary malignancies such as salivary duct carcinoma and high-grade mucoepidermoid carcinoma, as well as tumors located in the submandibular gland, show a higher likelihood of metastasizing. Acinic cell carcinoma is an uncommon salivary gland neoplasm that typically occurs in the parotid gland and is considered a low-grade malignancy. Metastasis is unusual and, if present, predominantly involves the lung and bones. However, vertebral metastasis is exceedingly rare. Here, we describe a rare case of recurrent acinic cell carcinoma of the parotid gland with widespread metastases to multiple bones, including the vertebrae, and to the liver, which was diagnosed in part by cytology. To our knowledge, this is the first report in the cytology literature to describe salivary gland acinic cell carcinoma with metastases to such distant sites and to discuss the resulting cytologic differential diagnoses.
Highlights
Salivary gland neoplasms are heterogeneous tumors that vary in anatomic site of origin, histopathology, and behavior, including metastatic potential [1]
We report a case of recurrent parotid Acinic cell carcinoma (AcCC) with widespread liver and bone metastases, diagnosed by fine needle aspiration (FNA) cytology and tissue biopsies
Primary acinar cell carcinoma of the liver is exceedingly rare, characterized by morphological acinar differentiation, architectural pattern and typical cytological features including pyramidal shape, granular cytoplasm, Periodic acid-Schiff staining with diastase digestion (PAS-D) staining, trypsin and chymotrypsin positivity [25,26]. These features resemble salivary AcCC, which is reported positive for alpha1-antichymotrypsin and alpha-1-antitrypsin [14,27]
Summary
Salivary gland neoplasms are heterogeneous tumors that vary in anatomic site of origin, histopathology, and behavior, including metastatic potential [1]. Acinic cell carcinoma (AcCC) is a low-grade salivary gland tumor, comprising 1-6% of salivary neoplasms [2,3,4,5,6]. It is slow-growing but capable of metastasizing, with rare reports involving regional lymph nodes, lungs, and bones [7,8,9,10,11,12,13,14]. There have been only few documented cases of vertebral metastases and limited cytology descriptions of metastatic AcCC. We report a case of recurrent parotid AcCC with widespread liver and bone metastases, diagnosed by fine needle aspiration (FNA) cytology and tissue biopsies
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