Acinic cell carcinoma of the lacrimal gland

Case contributed by A.Prof Frank Gaillard

Presentation

Adult presenting with right sided proptosis.

Patient Data

Age: Adult

A large extraconal low-density mass in the lateral aspect of the right orbit distorts and displaces the globe anteriorly. There is peripheral enhancement and no adjacent bony destruction. 

Case Discussion

The location of the mass and implied firm consistency (it distorts the globe)suggest the most likely diagnosis is that of a tumour of the lacrimal gland (rather than lymphoma or pseudotumour which tend to be softer and not distort the globe). 

The patient went on to have the mass resected.

Histology

Microscopic Description: 

The right lacrimal gland tumour demonstrates a neoplasm, which contains numerous papillae of neoplastic cells, and cystic spaces, which frequently contain degenerated blood and exfoliated cells. The cells are arranged in a variety of patterns, including solid, papillary and microfollicular. The cells have abundant eosinophilic cytoplasm, which is focally finely granular. Numerous cells containing small to large vacuoles are present.

Cells on the surface of the papillae frequently show a "tombstone" appearance. On PAS and Diastase stains occasional cells show faint granular staining and occasional small glands containing PAS-positive material are present.

The tumour is surrounded by a fibrous capsule of varying thickness. Tumour focally infiltrates into the capsule and just up to beneath the painted resection margin. The tumour stains strongly for keratin, which highlights the invasive features at the margin of the tumour.

Immunoperoxidase stains for smooth muscle actin, S100, P63 and GFAP are negative. 

FINAL DIAGNOSIS: The histologic features of this tumour are characteristic of an acinic cell carcinoma which is extremely rare within the lacrimal gland with only a handful of cases having been reported in the literature.

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Case information

rID: 9480
Published: 22nd Apr 2010
Last edited: 18th Mar 2018
System: Head & Neck
Inclusion in quiz mode: Included

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