We report the case of a 43-year-old man who consulted for a palpable mass, painful to pressure in the right preauricular region.
Physical examination revealed a poorly defined 2 cm mass in the right parotid area, with no other significant findings.
The patient reported no personal or family history of interest, only the nodule mentioned above, which, as indicated, had evolved for more than five years.
The imaging tests performed, computerized axial tomography and ultrasound, show a well-defined 2.5 x 2 cm tumor focused on the parotid, which does not affect bone or muscle structures, suggestive of low-grade tumor.
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Puncture aspiration was performed with needle dyeing, using the routine method of 3 passes with 23G needle, and help of Cameco® (manual aspirate device) technique was used after which the rest were fixed in alcohol.
The examination of the extended samples shows, on a seroproteinaceous background, abundant cellularity of large size, with central and occasionally peripheral nuclei, rounded, poorly patent and fine granular chromatin.
The cytoplasm is very characteristic, being abundant, pale and foamy edges unisolated, vacuolized and containing abundant violet granules.
Cells are arranged in more or less compact groups of large two-dimensional laminae, sometimes adopting an acinar architectural pattern.
Along with this predominant cellularity, smaller size cells with low cytoplasm and small rounded or oval central nucleus are also observed.
The cytological image was therefore consistent with serous acinar cell disease, probably carcinoma, so it was proposed to perform DNA quantification by imaging cytometry on cytological smears.
Since the smears obtained in the first puncture did not allow an adequate evaluation, a second FNA was performed with the purpose of progressive staining of Hematology, and the material for the cytometric determination was subsequently fixed with methyl alcohol 99.
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By means of the TEXCAN® software and through integrated video camera, a histoploid (Symploid-like) form was revealed (Symploid-type), captures gray scales, and determines the most relevant biological parameters.
With the cytological diagnosis of acinar cell carcinoma and the low-grade cytometric prognostic index, a conservative surgical intervention was performed, with excision of the parotid gland without cervical fixation and preserving the nerve.
Macroscopically, we found a whitish piece of polylobulated morphology with a weight of 12 grams and total measurements of 8 x 4 x 3 cm. At the cut, we found an apparently non-extremely cystic lesion of 1.5 cm.
We performed multiple parallel sections of the sample, which were embedded in paraffin and then stained with conventional hematoxylin-eosin.
Histopathological study shows a well circumscribed microcystic and solid neoformation composed mainly of acinar cells that do not overflow the glandular capsule.
The multiple cystic spaces of very small size, located between solid sheets are formed by luces covered by intercalated ductal cells, although acinar cells also participate occasionally.
Acinar cells are serously secreted, as demonstrated by PAS staining (Schiff periodic) highlighting intracystic acid eosinophilic zymogenic granules as well as intracytoplasmic acid secretion.
The neoplasm respects the extremes of resection and there is no evidence of vascular or nerve damage.
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The definitive diagnosis is therefore a low-grade, well-defined, malignant neoplasm of Acinar Cells without invasion of surgical extremes.
