Clear cell carcinoma

Question 1

Site

Answer 1

Parotid gland is the most common site
83% occur in the parotid
* Less common in SM gland – 2-4 %
* 10 – 13% occur intraorally

Most common malignant salivary gland tumor to occur bilaterally – 3% of time

Usually occurs in the BM and upper lip in monor salivary glands

Question 2

Epidemiology

Answer 2

Wide age range, from children to older adults (median: 52 years)

Slightly more common in females than in males

More common in White populations

Question 3

Prevelance

Answer 3

Most common malignant salivary gland tumor which may present with bilateral involvement.

Second most common salivary malignancy in children (after mucoepidermoid carcinoma)

Third most common salivary malignancy in adults (after mucoepidermoid carcinoma and adenoid cystic carcinoma)

Question 4

Etiology

Answer 4

Previous radiation exposure
Familial predisposition

Question 5

Clinical features

Answer 5

Solitary, Slow growing, Painless mass

Pain, Fixation to surrounding tissues and cranial nerve VII dysfunction are uncommon
Cervical lymph node metastasis uncommon (up to 10%)

Question 6

Investigations

Question 7

Histology

Answer 7

Serous acinar cells are characteristic

The tumor cells display a variety of growth patterns such as:
Solid, follicular, microcystic, and papillary cystic.

Solid and microcystic patterns are the most common and are often seen together.

Many acinic cell carcinomas contain a prominent lymphoid component with well-developed germinal centers. On fine needle aspirate biopsy, the acinic cells may be mistaken for oncocytic cells and, given the lymphoid component, may lead to a mistaken diagnosis of Warthin’s tumor.

Question 8

Treatment

Answer 8

Most are non-aggressive and have a good prognosis

• Better prognosis of any of the malignant SGT
• Minor gland tumors have a better prognosis- total excision
  of gland

Parotid Gland
* Superficial lobe – lobectomy
* Deep lobe – total parotidectomy

• Submandibular Gland – total removal of the gland
• Radiotherapy – only cases of uncontrolled local disease

Neck dissection is not indicated unless nodes are clinically involved. For incompletely resected tumor or metastatic disease, radiation therapy may be used.