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Year : 2016 Month : April Volume : 5 Issue : 34 Page : 1954-1956

ACINIC CELL CARCINOMA OF NASAL CAVITY: A RARE SITE FOR SALIVARY GLAND TUMOUR.

P. S. Jayalakshmy1, Rohini Sebastian2, M. Feroze3

1Professor, Department of Pathology, Government Medical College, Thrissur, Kerala, India.
2Junior Resident, Department of Pathology, Government Medical College, Thrissur, Kerala, India.
3Professor & HOD, Department of Pathology, Government Medical College, Thrissur, Kerala, India.

CORRESPONDING AUTHOR

Dr. P. S. Jayalakshmy,
Email : psjayalakshmy@gmail.com

ABSTRACT

Corresponding Author:
Dr. P. S. Jayalakshmy,
Parijatham,
Near Attore Road Bus Stop,
Kuttur P. O, Thrissur-680013,
Kerala, India.
E-mail: psjayalakshmy@gmail.com

ABSTRACT

BACKGROUND

We are herewith reporting a case of acinic cell carcinoma arising in nasal cavity in a 52-year-old male patient. The diagnosis was confirmed by immunohistochemistry for DOG1, which is a novel marker for salivary acinic cell differentiation. Nasal cavity is a rare site for acinic cell carcinoma and pathologists and surgeons should include this entity also in the differential diagnosis of tumours of nasal cavity to avoid misdiagnosis.

KEYWORDS

Acinic Cell Carcinoma, DOG1, Nasal Cavity, Salivary Gland.

INTRODUCTION

Salivary gland neoplasms are extremely rare in nasal cavity. The commonest benign tumour of salivary gland type in nasal cavity is pleomorphic adenoma and malignant, though rare is adenoid cystic carcinoma. Acinic cell carcinoma is uncommon in this location. The World Health Organisation defines acinic cell carcinoma as a malignant epithelial neoplasm of the salivary glands, in which at least some of the neoplastic cells demonstrate serous acinar cell differentiation characterized by cytoplasmic zymogen secretory granules.(1) Extensive search of English language medical literature showed only about 18 cases of acinic cell carcinoma previously described in sinonasal location.(2-4) DOG1/Anoctamin 1, a marker of gastrointestinal stromal tumour, a calcium activated chloride channel protein is also expressed in acinic cells of salivary gland and is useful for delineating acinic cell differentiation in these tumours.(5) We hereby report the clinicopathological features and the role of DOG1 immunomarker for diagnosis in a case of acinic cell carcinoma of nasal cavity.

CASE REPORT

A 52-year-old previously healthy man presented to our hospital with a 6 months history of nasal obstruction and recurrent epistaxis. Rhinoscopic examination revealed a single polypoid lesion filling right nasal cavity, which was sensitive to touch but did not bleed. CT scan of nose and paranasal sinuses showed right-sided single polypoid nasal mass filling and confined to the nasal cavity with mild right maxillary sinusitis (Figure 1). The mass was seen to arise from the right middle turbinate. No intracranial extension was noted in CT brain. The patient underwent

endoscopic nasal mass excision biopsy. We received multiple grey brown and grey white soft tissue bits aggregate measuring 6x5x1 cm.Histopathological examination revealed fragments of tissue lined by respiratory type epithelium (Figure 2a) and a neoplasm composed of cells arranged in sheets (Figure 2b) and in acinar pattern with many microcystic spaces (Figure 2c). Individual cells were polygonal with abundant granular basophilic cytoplasm and basally located round to oval bland nuclei (Figure 2d). PAS stain done showed cytoplasmic granules in the neoplastic acinar cells (Figure 3a), which was diastase resistant. Immunohistochemistry (IHC) was done. The neoplastic cells showed strong diffuse positivity with Cytokeratin 7 (CK 7) (Figure 3b). IHC with DOG1 showed strong apical membranous positivity in the neoplastic cells, which is the pattern consistent with acinar cell differentiation (Figure 3c & 3d).

 

Fig. 1: CT Scan showing Right Nasal Mass


Fig. 2a: Tissue Lined by Respiratory Mucosa (H&E x100)


Fig. 2b: Neoplasm showing Solid Pattern (H&E x100)