Abstract
While salivary gland tumors have considerable plasticity, juxtaposition of the morphologies of two named tumor types is rare. Tumors with both mucoepidermoid and serous acinar components, dubbed “mucoacinar” carcinomas were recently characterized, and based on morphologic and molecular features, considered variants of mucoepidermoid carcinoma. Here we describe a unique case of a 59-year-old male with a 0.9 cm right parotid mass with a similar blend of mucoepidermoid-like and acinar elements that instead has a molecular phenotype of acinic cell carcinoma, essentially the reverse of mucoacinar carcinoma. The tumor was fairly well circumscribed with a prominent tumor associated lymphoid response. It consisted of a predominant bland but basaloid squamoid proliferation with scattered pockets of serous acinar differentiation as well as rare mucous cells and tubules. The tumor showed diffuse cytokeratin and DOG1 reactivity as well as p40 expression in the squamoid components. Immunostaining for NR4A3 was diffusely positive, and an NR4A3 rearrangement was noted on fluorescence in situ hybridization, while testing for MAML2 and MSANTD3 rearrangements were negative. Based on these findings, this tumor is best considered a “squamoglandular variant of acinic cell carcinoma.” Morphologic and clinical evidence argues against this representing a form of high-grade transformation. While overall bland, the differential diagnosis may include various basaloid tumors in the parotid gland, both primary and metastatic.
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Nasse D. Die geschwülste der speicheldrülen und verwandte tumoren des kopfes. Arch Klin Chir. 1892;44:233–302.
Godwin JT, Foote FW, Jr., Frazell EL. Acinic cell adenocarcinoma of the parotid gland; report of twenty-seven cases. Am J Pathol. 1954;30(3):465–77.
Buxton RW, Maxwell JH, French AJ. Surgical treatment of epithelial tumors of the parotid gland. Surg Gynecol Obstet. 1953;97(4):401–16.
Simpson RHW, Chiosea S, Katabi N, Leivo I, Vielh P, Williams MD. Acinic cell carcinoma. In: El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ, editors. WHO classification of head and neck tumors. 5th ed. Lyon: IARC; 2017. p. 166–7.
Abrams AM, Cornyn J, Scofield HH, Hansen LS. Acinic Cell Adenocarcinoma of the Major Salivary Glands. A Clinicopathologic Study of 77 Cases. Cancer. 1965;18:1145–62.
Stanley RJ, Weiland LH, Olsen KD, Pearson BW. Dedifferentiated acinic cell (acinous) carcinoma of the parotid gland. Otolaryngol Head Neck Surg. 1988;98(2):155–61.
Thompson LD, Aslam MN, Stall JN, Udager AM, Chiosea S, McHugh JB. Clinicopathologic and Immunophenotypic Characterization of 25 Cases of Acinic Cell Carcinoma with High-Grade Transformation. Head Neck Pathol. 2016;10(2):152–60.
Skalova A, Sima R, Vanecek T, Muller S, Korabecna M, Nemcova J, et al. Acinic cell carcinoma with high-grade transformation: a report of 9 cases with immunohistochemical study and analysis of TP53 and HER-2/neu genes. Am J Surg Pathol. 2009;33(8):1137–45.
Chiosea SI, Griffith C, Assaad A, Seethala RR. The profile of acinic cell carcinoma after recognition of mammary analog secretory carcinoma. Am J Surg Pathol. 2012;36(3):343–50.
Ferreiro JA, Kochar AS. Parotid acinic cell carcinoma with undifferentiated spindle cell transformation. J Laryngol Otol. 1994;108(10):902–4.
Gnepp DR, Wang LJ, Brandwein-Gensler M, Slootweg P, Gill M, Hille J. Sclerosing polycystic adenosis of the salivary gland: a report of 16 cases. Am J Surg Pathol. 2006;30(2):154–64.
Bundele M, Weinreb I, Xu B, Chiosea S, Faquin W, Dias-Santagata D, et al. Mucoacinar Carcinoma: A Rare Variant of Mucoepidermoid Carcinoma. Am J Surg Pathol. 2021;45(8):1028–37.
Andreasen S, Varma S, Barasch N, Thompson LDR, Miettinen M, Rooper L, et al. The HTN3-MSANTD3 Fusion Gene Defines a Subset of Acinic Cell Carcinoma of the Salivary Gland. Am J Surg Pathol. 2019;43(4):489–96.
Haller F, Bieg M, Will R, Korner C, Weichenhan D, Bott A, et al. Enhancer hijacking activates oncogenic transcription factor NR4A3 in acinic cell carcinomas of the salivary glands. Nat Commun. 2019;10(1):368.
Gnepp DR, Schroeder W, Heffner D. Synchronous tumors arising in a single major salivary gland. Cancer. 1989;63(6):1219–24.
Seifert G, Donath K. Hybrid tumours of salivary glands. Definition and classification of five rare cases. Eur J Cancer B. 1996;32B(4):251–9.
Nagao T, Sugano I, Ishida Y, Asoh A, Munakata S, Yamazaki K, et al. Hybrid carcinomas of the salivary glands: report of nine cases with a clinicopathologic, immunohistochemical, and p53 gene alteration analysis. Mod Pathol. 2002;15(7):724–33.
Grenko RT, Abendroth CS, Davis AT, Levin RJ, Dardick I. Hybrid tumors or salivary gland tumors sharing common differentiation pathways? Reexamining adenoid cystic and epithelial-myoepithelial carcinomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86(2):188–95.
Bishop JA, Westra WH. MYB Translocation status in salivary gland epithelial-myoepithelial carcinoma: evaluation of classic, variant, and hybrid forms. Am J Surg Pathol. 2017;42:319.
Croitoru CM, Suarez PA, Luna MA. Hybrid carcinomas of salivary glands. Report of 4 cases and review of the literature. Arch Pathol Lab Med. 1999;123(8):698–702.
Snyder ML, Paulino AF. Hybrid carcinoma of the salivary gland: salivary duct adenocarcinoma adenoid cystic carcinoma. Histopathology. 1999;35(4):380–3.
Hellquist H, Skalova A, Azadeh B. Salivary gland hybrid tumour revisited: could they represent high-grade transformation in a low-grade neoplasm? Virchows Arch. 2016;469(6):643–50.
Ballestin C, Lopez-Carreira M, Lopez JI. Combined acinic cell mucoepidermoid carcinoma of the parotid gland. Report of a case with immunohistochemical study. APMIS. 1996;104(2):99–102.
Roy S, Dhingra KK, Gupta P, Khurana N, Gupta B, Meher R. Acinic cell carcinoma with extensive neuroendocrine differentiation: a diagnostic challenge. Head Neck Pathol. 2009;3(2):163–8.
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AAS and RRS performed pathologic interpretation, performed literature search, and wrote the manuscript.
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Shah, A.A., Seethala, R.R. Squamoglandular Variant of Acinic Cell Carcinoma: A Case Report of a Novel Variant. Head and Neck Pathol 16, 870–875 (2022). https://doi.org/10.1007/s12105-021-01399-1
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DOI: https://doi.org/10.1007/s12105-021-01399-1