|Year : 2014 | Volume
| Issue : 2 | Page : 220-222
Acinic cell carcinoma of the nasal cavity
K.S. Gangadhara Somayaji, Zainab Sunu Ali, Mohammad Nalapad Abdulla, Vijin Ravindran Nambiar, Tom Koshy Johns
Department of ENT, Yenepoya Medical College, Mangalore, Karnataka, India
|Date of Web Publication||11-Nov-2014|
Zainab Sunu Ali
Department of ENT, Yenepoya Medical College, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Acinic cell carcinoma presenting in the nasal cavity is a rare entity. Here we report a case of a 65-year-old female patient who presented with a history of epistaxis and nasal obstruction. The case was diagnosed as acinic cell carcinoma. The tumor was found to be arising from the lateral wall of the right nasal cavity and it was treated by surgical excision and regular follow-up. This tumor is usually found in the major salivary glands and has a low grade behavior with the best survival rate of any salivary malignancy. We present a rare case presenting in the lateral wall of the nasal cavity. The clinical, histopathological features, and the management of this tumor is described with a review of the relevant literature.
Keywords: Acinic cell carcinoma, bilateral nasal obstruction, epistaxis, mid-facial degloving
|How to cite this article:|
Somayaji KG, Ali ZS, Abdulla MN, Nambiar VR, Johns TK. Acinic cell carcinoma of the nasal cavity
. Arch Med Health Sci 2014;2:220-2
| Introduction|| |
Acinic cell carcinoma is a tumor of the salivary gland which may rarely present in ectopic sites. It is a rare form of tumor accounting for 6-8% of all salivary malignancies. This tumor has a low-grade behavior and is associated with the best survival rate of any salivary malignancy. These tumors can be seen in the major salivary glands, minor salivary glands including lips, palate, neck, buccal mucosa and other ectopic sites.  We report a case of acinic cell carcinoma arising from the lateral wall of the right nasal cavity.
| Case Report|| |
The present case report is about a 65-year-old female patient who presented with a history of epistaxis since many years and bilateral nasal obstruction since 1 year. Patient presented with an increase in the frequency and severity of epistaxis of 2 weeks duration, which was seen on blowing the nose. There was no history of spontaneous episodes of epistaxis. Nasal obstruction was gradually progressive and complete. On examination, patient appeared pale. Examination of the nose revealed a pink fleshy mass filling up the right nasal cavity between the turbinates and the septum. The mass was firm in consistency, bled on touch and anterior most part could be probed all around. The nasal mucosa was congested and the right inferior turbinate was normal. Examination of the left nasal cavity revealed a high deviation of the nasal septum to the left and a similar pink fleshy mass toward the floor of the nasal cavity. Left inferior turbinate was normal. The mass was firm in consistency and bled on touch. Post-nasal examination was normal. Examination of the face revealed a diffuse swelling of the right cheek measuring 3 cm × 2 cm extending from malar prominence to the angle of the mouth. It was soft in consistency. Rest of the ear, nose and throat examination was normal. Diagnostic nasal endoscopy confirmed the clinical findings. Complete blood count and biochemical parameters were within normal range.
Computed tomography scan of nose and paranasal sinuses with contrast revealed a heterogeneously enhancing soft-tissue density mass lesion in right nasal cavity causing destruction of the nasal septum and extending into the left nasal cavity, obliterating the right osteomeatal unit with fluid collection in the right maxillary sinus and right ethmoid and frontal sinus. The features were suggestive of a neoplasm [Figure 1]. Biopsy of the mass from both nasal cavities revealed acinic cell carcinoma [Figure 2]. Patient underwent midfacial degloving with excision of the nasal mass under general anesthesia [Figure 3]. The macroscopic findings during the operation suggested that the mass was seen arising from the area between the right inferior and middle turbinate on the lateral wall. It was perforating the cartilage and bony septum posteriorly extending up to the left nasal cavity on the floor. Mass was excised in total along with the area of the involved septum [Figure 4]. The post-operative period was uneventful. Follow-up of the patient was carried out up to 1 year and she was symptom free.
|Figure 1: Coronal cut of computed tomography scan of the nose showing heterogeneously contrast enhancing soft-tissue density mass lesion in right nasal cavity causing destruction of the nasal septum and extending into the left nasal cavity|
Click here to view
|Figure 2: Histopathological photograph of the tumor showing tumor cells with basophilic to clear cytoplasm|
Click here to view
Histopathology showed moderate size tumor cells with basophilic to clear cytoplasm with Periodic Acid Schiff positivity. The cells were arranged in sheets, acinar pattern and trabecular pattern. Nuclei were central to peripheral and were round and light stained which were slightly pleomorphic. The margin of the excised specimen was tumor free. In this case, no further treatment was given post-operatively.
| Discussion|| |
Acinic cell carcinoma has been reported to occur in the minor salivary glands of the oral cavity. There are very few reported cases of the tumor occurring in the nose. It is thought to account for 1-4% of malignant nasal neoplasms.  Sapçi et al. in their study have reported a case of left side nasal obstruction since 1 month with tumor arising from the left anterior nasal septum. The tumor was excised surgically. 
Sahasrabudhe et al. have reported a case of tumor arising from the left inferior turbinate which was treated by surgical excision.  Other literature report tumor arising from the nasal vestibule.  In all cases, it was treated surgically and subsequently patients were kept on regular follow-up to rule out recurrence. ,,
Ellis and Cori reviewed 294 cases of acinic cell carcinoma at Armed Forces Institute of Pathology and found that the parotid gland was the most common site of origin. They also reported histologic subtypes as solid (38%), microcystic (33%), papillary cystic (25%) and follicular (4%), consistent with other reports.  Batsakis et al. suggested a three-tiered grading system to replace the traditional histologic variants: Solid-lobular; acinar-microcystic, pilocystic, tubuloductal, follicular; and dedifferentiated.  Abrams et al. reported growth patterns as solid, microcystic, papillary-cystic and follicular. One or more growth patterns maybe present in the same tumor. The cellular features were identified as acinar, intercalated ductal, vacuolated, clear and nonspecific glandular.  Our case showed an acinar cell type arranged in sheets and trabeculae.
Primary treatment is complete surgical resection. Post-operative radiation is not routinely advocated for these low-grade salivary malignancies but may be used for advanced or high grade tumors  or recurrent tumors, tumors with positive surgical excision margins or tumors with extensive perineural and/or lymphovascular invasion.  Batsakis et al. divided the tumor histologically into high and low-grade lesions. High-grade lesions demonstrate aggressive local invasion, extraparenchymal invasion, medullary growth architecture and prominence of undifferentiated cells. 
Regional lymph node metastasis is seen in 10-16% respectively.  Local recurrence was noted in 33%, with better control for lower stage tumors. Distant metastases developed in 12% of the patients and were usually associated with local recurrence, with 3-10 month survival from discovery of metastasis. Survival rates were 83%, 76% and 65% 5, 10 and 15 years respectively after initial therapy. Although most series report a low-grade behavior for acinic cell carcinomas, other authors have suggested a potential for dedifferentiation and hence more aggressive clinical behavior of high-grade tumors.  Hence, these tumors require a long-term follow-up.
| References|| |
|1.||Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, et al., editors. Cummings Otolaryngology, Head and Neck Surgery. 4 th ed. Pennsylvania: Mosby, Inc.; 2005. p. 1386-8. |
|2.||Spiro RH, Huvos AG, Strong EW. Acinic cell carcinoma of salivary origin. A clinicopathologic study of 67 cases. Cancer 1978;41:924-35. |
|3.||Sapçi T, Yìldìrìm G, Peker K, Karavus A, Akbulut UG. Acinic cell carcinoma originating in the nasal septum. Rhinology 2000;38:140-3. |
|4.||Sahasrabudhe N, Aslam MB, Morar P. Acinic cell carcinoma arising in the nasal cavity. Otolaryngologist 2011;4:83-5. |
|5.||Manganaris A, Bates TJ, Roberts D, Simo R. Acinic cell carcinoma of the nasal vestibule. Report of a unique case. Rhinology 2010;48:113-6. |
|6.||Ellis GL, Corio RL. Acinic cell adenocarcinoma. A clinicopathologic analysis of 294 cases. Cancer 1983;52:542-9. |
|7.||Batsakis JG, Luna MA, el-Naggar AK. Histopathologic grading of salivary gland neoplasms: II. Acinic cell carcinomas. Ann Otol Rhinol Laryngol 1990;99:929-33. |
|8.||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. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]