Acinic Cell Carcinoma of the Parotid Gland

Alyssa Mellott
Anatomy 3672
Case Study
1. Kelley, Lorrie L., and Connie M. Peterson. Sectional Anatomy for Imaging
Professionals. 3rd ed. St. Louis: Elsevier, 2013. Print.

2. Lee, Steve. "Salivary Gland Neoplasms." MedScape. WebMD, 8 Mar. 2013. Web. 18
Mar. 2014.
<http://emedicine.medscape.com/article/852373-overview#a0112>.
3. Amirlak, Bardia. "Malignant Parotid Tumors." MedScape. WebMD, 27 Feb. 2013.
Web. 18 Mar. 2014.
<http://emedicine.medscape.com/article/1289616-overview>.
4. American Cancer Society. Salivary Gland Cancer. N.p.: American Cancer Society,
2014. PDF.

5. Hackworth, Ruth. "Paranasal Sinuses and Orbits." Feb. 2014. Lecture

The major salivary glands include the parotid, submandibular, and sublingual glands.
The parotid gland is the largest of the three, and is divided into superficial and deep lobes.
It is located anterior to the auricle, and between the mandibular ramus and the
sternocleidomastoid muscle. It extends inferiorly from the level of the external auditory
meatus to the angle of the madible. Stensons duct emerges from the anterior edge of the
gland, and passes under the zygomatic arc to drain the parotid gland into the oral cavity.1
The parotid gland has possible lymph drainage to the pre-auricular, infra-auricular, and
deep jugular nodes. Salivary gland tumors make up 6% of all head and neck tumors, and
80% of them are located in the parotid gland.2 The most common histology for parotid
malignancies is mucoepidermoid carcinoma.
None of the risks associated with parotid gland malignancies have particularly high
correlations, but previous radiation therapy, occupational exposure to dust, and cell phone
use are a few of the possible contributing factors. Most of the presenting symptoms linked

to parotid tumors occur in the mouth and ear area on the ipsilateral side of the disease.
The patient commonly experiences a lump or pain in the mouth, cheek, or jaw, numbness
in part of the face, and fluid draining from the ear. 3
This information is relevant to a 35-year-old female being treat at the James Cancer
Hospital. She smoked for 8 years and has history of thyroid, prostate, and breast cancer in
her family. This patient presented with a mass in her right parotid region, facial nerve
synkenesis, and lip elevation with blinking. She was also experiencing pain in her V2
distribution, and a sensation of cold water on face while eating. The patient was eventually
diagnosed with a low-grade acinic cell carcinoma of the right parotid gland. This is
especially rare considering males over 60 are the most common population to develop
malignant salivary gland tumors. Another unique aspect of this case is the patients medical
history. She had a parotidectomy at a different hospital in 2010 for a supposed benign
growth in her right parotid gland. She recovered fully from this operation, but there are
obvious questions about whether the correct histology was originally diagnosed. Ohio
State has requested to review the diagnostic information leading to her parotidectomy.
Surgery and radiation therapy are most often utilized when it comes to the treatment of
salivary gland tumors. Since this patient already had her parotid gland removed, she is just
receiving radiation therapy with a total dose of 60 Gy. As a result of her treatments, she
has started to develop skin irritation, dry mouth and loss of hair. Some long-term effects of
radiation include a decrease in thyroid function, decreased hearing, and loss of taste. For
salivary gland tumors, American Joint Committee on Cancer staging is used. This patient
has was staged T1 N0 M0. This means that her tumor is 2cm or smaller (T1), there is no
spread to regional lymph nodes (N0), and no distant metastasis (M0). It is also a low
grade, therefore the cells are well differentiated and the tumor is slow growing. The major

determinants of survival for salivary gland cancers are history and clinical stage. The
overall 5-year survival for all stages and histologic types is approximately 62%.
Unfortunately, 20% of patients with parotid gland tumors will have distant metastasis. 4
This patient does not currently have any metastasis or lymph node spread, and her
prognosis looks fair according to her documents.

Above left: basic anatomy of the parotid gland

Above right: Stensons duct (parotid duct) entering the oral cavity

Above left: V2 distribution, where the patient was experiencing pain

Above right: parotid nerves leading to this area

Above left: example- an MRI before a parotidectomy

Above right: example- an MRI after a parotidectomy

Above: example- MRI of a right parotid gland tumor

Above: example- CT scans showing a right parotid gland tumor from

superior to inferior

Above: This patients digitally reconstructed radiographs showing her

radiation therapy treatment fields