Acinic Cell Carcinoma


What is Acinic Cell Carcinoma?

Acinic Cell Carcinoma is a low-grade neoplasm occurs on the epithelial cell lining of the salivary gland. A gradual mass progression of the terminal end of the parotid gland usually affected. Almost 17 percent of the primary salivary gland carcinoma is related to the Acinic Cell Carcinoma.

The onset of Acinic Cell Carcinoma considerably occurs at a younger age and the predominance is relatively high in females(1).

History of Acinic Cell Carcinoma

Godwin et al. first referred Acinic Cell Carcinoma almost 50 years prior. The “acinar” term is derived from Latin term “acinus”, which means a cluster of and looks like grapes branch. The histological appearance is quite similar to secretory parenchymatous cells. Before discovering this disease, clinically Acinic Cell Carcinoma was unrecognized.

At the time after recognizing the disease, it thought to be the nature of the tumor is benign. But afterward, it has been detected that the recurrence tendency of the tumor showed the possibility of the malignant nature of the tumor. Later WHO (World Health Organization) re-classified as a “malignant carcinoma” with low-grade behavior (2, 3).

Acinic Cell Carcinoma Epidemiology

The total incidence of salivary gland cancer is almost 0.6% in respect of total cancer incidence. Almost 6 percent to 8 percent of all type of salivary gland carcinoma and 17 percent of primary salivary gland carcinoma. According to the prevalence of this disease, Acinic Cell Carcinoma is a third most common salivary gland cancer. Both adult and children can develop Acinic Cell Carcinoma.


Women have a higher risk than the men. Usually, 52 years are considered as median age for onset of the condition. However, below 30 years age group people can also detect with Acinic Cell Carcinoma. The usual detected size of the tumor is 2 cm. Only 2/3rd of the Acinic Cell Carcinoma affected individual get early diagnosis and treatment at the first stage. But the risk of a larger area or distant metastasis, larger sized and high-grade tumor risk increased with increasing of age. (2,3)

Acinic Cell Carcinoma Causes

Certain risk factors trigger Acinic Cell Carcinoma, which includes


  • Previous history of exposure to radiation exposure
  • Familial predisposition
  • Gender specification like women have more prevalence to develop malignant Acinic Cell Carcinoma
  • Scientist identified that exposure to atomic bomb explosion can also increase the risk of Acinic Cell Carcinoma after investigating Hiroshima and Nagasaki atomic bomb explosion.
  • Occupational hazardous like workers working in rubber and asbestos manufacturing company, nickel exposure for the plumbing industry, automobile industry, wood factory or servicing in beauty shops or hairdressing shops also exposure to multiple chemicals, which often harmful for health and causes Acinic Cell Carcinoma.
  • Generally, hormonal involvement is less in the incidence of Acinic Cell Carcinoma. But in fewer cases, Estrogen, Progesterone and Androgen receptors have associated with Acinic Cell Carcinoma. Therefore, experts believe that Acinic Cell Carcinoma has linked with hormonal involvement. (1,2,3)

Immunohistochemistry

The histology of the Acinic Cell Carcinoma looks like encapsulated, solitary, gray-white colored soft tumor cells. In the case of recurrence, the cells are looks like lobulated, no capsule and cellular necrosis at the affected may also considerable for histology.

Another specific cellular unusual growth includes intercalated ductal, papillary-cystic, acinar, clear, microcystic, vacuolated, and follicular growth patterns(3,4).


Diagnosis

The following diagnostic tests are performed to detect the Acinic Cell Carcinoma.

  • Fine Needle Aspiration Biopsy (FNAB) are responsible for Acinic Cell Carcinoma diagnosis.
  • Ultrasonography, nuclear scans, CT scan and MRI can usually conduct for assessing the size of the tumor, location, and the nature of the tumor. (3,4)

Management

The following are the therapeutic management available for Acinic Cell Carcinoma:

Surgical

The possible surgical intervention for Acinic Cell Carcinoma are as follows:

  • Nerve grafting
  • Cervical lymphadenectomy
  • Total parotidectomy with removal of the facial nerve
  • Neck dissection

Radiation

The radiation therapy is applied in the following cases like:

  • Postoperative treatment
  • Adjuvant Salivary gland cancer

Chemotherapy

In Acinic Cell Carcinoma, chemotherapy is not fully effective, only chemotherapy is effective for pain-relief. Sometimes they can provide partial responses. The inefficiency of the chemotherapy is due to chemo-resistant nature of the Acinic Cell Carcinoma. (2,3,4)

Prognosis and Survival Rate

Acinic Cell Carcinoma usually has a good prognosis, because of low-grade carcinogenic effect. However, in certain cases, the prognosis is poor, which is depends upon the subsets present in the carcinogenic cells. The survival rate is high, almost 91 percent of the affected individuals have 5 years survival and 88 percent patients have 10 years survival. But in the case of high-grade Acinic Cell Carcinoma, only 33 percent affected individuals have 5 years survival rate. (3)

References

  1. What Is Salivary Gland Cancer?. American Cancer Society. https://www.cancer.org/
  2. Al-Zaher N, Obeid A, Al-Salam S, Al-Kayyali BS. Acinic cell carcinoma of the salivary glands: a literature review. Hematol Oncol Stem Cell Ther. 2009;2(1):259-64. https://www.ncbi.nlm.nih.gov/pubmed/20063555
  3. N Al-Zaher, (2009). Acinic cell carcinoma of the salivary glands: a literature review. http://www.sciencedirect.com/science/article/pii/S1658387609500350#bb0005
  4. Tarek A. Saleh, Kim N. Hakin, Michael J. Davidson. Metastasis of Acinic Cell Carcinoma of the Parotid Gland to the Contralateral Orbit. Arch Ophthalmol. 2003;121(12):1783-1786. doi:10.1001/archopht.121.12.1783. http://jamanetwork.com/journals/jamaophthalmology/fullarticle/415911

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