Roy Somak, Dhingra Kajal Kiran, Gupta Parul, Khurana Nita, Gupta Bulbul, Meher Ravi
Department of Pathology, Maulana Azad Medical College, New Delhi, India.
Head Neck Pathol. 2009 Jun;3(2):163-8. doi: 10.1007/s12105-009-0114-5. Epub 2009 Mar 26.
Primary salivary gland carcinoma with neuroendocrine differentiation is of rare occurrence, especially so in the parotid gland. Amongst the various reported primary tumors with neuroendocrine differentiation, acinic cell carcinoma (ACC) one such tumor. A 48 year old lady presented with a gradually increasing right infra-auricular swelling for a period of 1 year which enlarged suddenly in a short period. Contrast Enhanced Computed Tomography (CECT) suggested diagnosis of Pleomorphic Adenoma. Fine Needle Aspiration Cytology (FANC) yielded a cystic fluid suggesting a possibility of Warthin's tumor or Oncocytic lesion. Intraoperative findings were suggestive of a Warthin's tumor. Initial histopathological examination of the tumor was suggestive of neuroendocrine carcinoma. However, extensive sectioning revealed peripheral islands of ACC. Immunoexpression of S-100, Neuron specific Enolase (NSE), Chromogranin A and Synaptophysin confirmed the diagnosis. The possibility of neuroendocrine differentiation in a primary salivary gland tumor should be kept in mind whenever a salivary gland tumor shows only neuroendocrine histology.
伴有神经内分泌分化的原发性涎腺癌较为罕见，在腮腺中尤为如此。在各种已报道的具有神经内分泌分化的原发性肿瘤中，腺泡细胞癌（ACC）就是这样一种肿瘤。一名48岁女性患者右耳下肿胀逐渐加重1年，短期内突然增大。增强计算机断层扫描（CECT）提示多形性腺瘤诊断。细针穿刺细胞学检查（FANC）抽出囊性液体，提示可能为沃辛瘤或嗜酸性细胞病变。术中所见提示为沃辛瘤。肿瘤的初步组织病理学检查提示为神经内分泌癌。然而，广泛切片显示周边有ACC岛状结构。S-100、神经元特异性烯醇化酶（NSE）、嗜铬粒蛋白A和突触素的免疫表达证实了诊断。当涎腺肿瘤仅表现为神经内分泌组织学时，应考虑原发性涎腺肿瘤中神经内分泌分化的可能性。
