|
STATISTICS
|
SOURCE
|
PUBLICATION DATE
|
TIME PERIOD STUDIED
|
# OF PATIENTS IN STUDY
|
|
All new
carcinomas of the major salivary glands reported to the National Swedish
Cancer Registry 1960-1995 were reviewed. The study comprised 2465 patients with carcinoma of the
parotid or submandibular glands. Relative survival differed markedly
according to histopathological typing (P<0.001). For parotid tumors,
acinic cell carcinomas had the best prognosis with a 10-year relative
survival of 88%.
|
Oral Oncol
2002 Oct;38(7):706
Carcinoma of
the parotid and submandibular glands-a study of survival in 2465 patients.
Wahlberg P,
Anderson H, Biorklund A, Moller T, Perfekt R.
Department of
Otorhinolaryngology, Head and Neck Surgery, University Hospital, S-221 85,
Lund, Sweden
|
Oct. 2002
|
1960-1995
|
2465 various carcinomas
of major salivary glands
|
|
Acinic Cell
Adenocarcinoma accounts
for about 6% of all salivary gland tumors.
|
UCLA School of Medicine
website:
http://wwwpathnet.medsch.
ucla.edu/med-edu/
pathrev/saliv/mt/acinic.htm
|
As of 6/2002
|
|
|
|
The vast
majority (83%) occur within the parotid gland, usually as a slowly enlarging
mass.
|
The Doctorıs Doctor.com
page on Acinic Cell Carcinoma:
http://www.thedoctorsdoctor.com/
diseases/aciniccell_ca.htm
|
As of 6/2002
|
|
|
|
EPIDEMIOLOGY:
Incidence:
3rd most common epithelial malignancy of the salivary gland.
17% of all
primary salivary gland malignancies
6% of
salivary gland neoplasms
Age
Range - Median: Mean age is 44 years
12% of
patients < 20 years
Sex
(M:F): 2:3
Geography:
No racial predilection
|
The Doctorıs Doctor.com
page on Acinic Cell Carcinoma:
http://www.thedoctorsdoctor.com/
diseases/aciniccell_ca.htm
|
As of 6/2002
|
|
|
|
Synchronous
or metachronous:
3% of cases
are bilateral
|
The Doctorıs Doctor.com
page on Acinic Cell Carcinoma:
http://www.thedoctorsdoctor.com/
diseases/aciniccell_ca.htm
|
As of 6/2002
|
|
|
|
PROGNOSIS: Poor
factors include:
- Short duration of symptoms
- Incomplete excision
- Frequent mitoses
- Focal necrosis
- Neural invasion
- Pleomorphism
- Infiltration
- Stromal hyalinization
- Large size
- Involvement of the deep lobe of
the parotid gland
|
The Doctorıs Doctor.com
page on Acinic Cell Carcinoma:
http://www.thedoctorsdoctor.com/
diseases/aciniccell_ca.htm
|
As of 6/2002
|
|
|
|
SURVIVAL: About 16% die from the tumor.
RECURRENCE:
35%, usually within first 5 years after resection of the primary tumor.
METASTASIS: 16%
|
The Doctorıs Doctor.com
page on Acinic Cell Carcinoma:
http://www.thedoctorsdoctor.com/
diseases/aciniccell_ca.htm
|
As of 6/2002
|
|
|
|
TREATMENT: Complete surgical excision.
Radiation
may improve survival in patients for whom complete surgical excision cannot
be achieved.
|
The Doctorıs Doctor.com
page on Acinic Cell Carcinoma:
http://www.thedoctorsdoctor.com/
diseases/aciniccell_ca.htm
|
As of 6/2002
|
|
|
|
Overall, salivary cancers make up approximately 3% of
all head and neck malignancies that are diagnosed in North America each year;
most of these are in the parotid glands. Sublingual and minor salivary gland
cancers are unusual.
Overall, the majority of salivary gland neoplasms are benign, a
fact that reflects an overwhelming predominance of parotid tumors,
three-fourths of which are nonmalignant.
Acinic cell carcinoma is an uncommon malignancy that probably
accounts for fewer than 10% of all salivary gland cancers. Although acinic cell lesions usually are seen
in the parotid gland, they occasionally occur in the submandibular gland.
They
are low grade, only infrequently invade the facial nerve, and are late to
metastasize. When they do metastasize, however, it is usually to the lungs,
and under these circumstances, death usually follows. Because of their slow
growth, survival data are good when generous surgical excision is performed.
|
Cancer:
Principles & Practice of Oncology, 6th Edition
Author(s):
Vincent T. DeVita, Jr., MD, Samuel Hellman, MD, Steven A. Rosenberg, MD, PhD
Date: January 2001
Chapter 30.4: Tumors of the Salivary Glands and Paragangliomas
Roy B.
Sessions
Louis B.
Harrison
Arlene A.
Forastiere
Major Salivary Gland
Tumors:
Acinic Cell Carcinoma
References:
Spiro R. Salivary neoplasms: overview of 25 years' experience
with 2,807 patients. Head Neck Surg 1986;8:177.
Perzin K, Livoisi V. Acinic cell carcinoma arising in ectopic
salivary gland tissue. Cancer 1980;45:967.
|
January 2001
|
|
|
|
Symptoms:
Most
patients with benign tumors, whether in minor or major salivary glands,
present with asymptomatic swelling of the lip or the parotid, submandibular,
or sublingual glands (floor of the mouth). Neurologic signs, such as mucosal
or tongue numbness, associated with a floor of mouth mass usually indicate a
malignancy. In the presence of a lip mass, a numb lower lip can result from
tumor involvement of the submental nerve. Facial nerve weakness that is
associated with a parotid or submandibular tumor is an ominous finding. Even
in huge tumors of the parotid gland that are benign, the facial nerve usually
is not affected. Essentially, any compromise in nerve function greatly
heightens concern for malignancy. Overall, malignant parotid gland tumors are
associated with facial nerve paralysis in 10% to 20% of patients. Although benign tumors occasionally cause facial
discomfort, persistent facial pain is strongly suggestive of malignancy in a
salivary gland tumor; in fact, approximately 10% to 15% of patients with
malignant parotid neoplasms present with pain. Furthermore, those malignancies that are characterized by
pain seem to have a worse prognosis.
The majority of parotid tumors, whether benign or malignant,
present with an asymptomatic mass in the gland; in fact, this is the case
even in the majority of malignant tumors.
|
Cancer:
Principles & Practice of Oncology, 6th Edition
Author(s):
Vincent T. DeVita, Jr., MD, Samuel Hellman, MD, Steven A. Rosenberg, MD, PhD
Date: January 2001
Chapter 30.4: Tumors of the Salivary Glands and Paragangliomas
Roy B.
Sessions
Louis B.
Harrison
Arlene A.
Forastiere
Major Salivary Gland
Tumors:
References:
Spiro R, Huvos A, Strong E. Cancer of the parotid gland. Am J
Surg
1975;130:452
Frankenthaler R, Luna M, Lee S, et al. Prognostic variables in
parotid gland cancer. Arch Otolaryngol Head Neck Surg
1991;117:1251.
|
January 2001
|
|
|
|
STATISTICS
|
SOURCE
|
PUBLICATION DATE
|
TIME PERIOD STUDIED
|
# OF PATIENTS IN STUDY
|
Salivary gland cancers are very uncommon and
account for less than 1% of all cancers, and about 7% of cancers of the head
and neck area. The survival rates for malignant salivary gland tumors depend
on the cell type and the stage of the cancer. The stage of the cancer depends
on its size and whether or not it has spread to other parts of the body.
|
What Are the Key Statistics for Salivary Gland Cancer?
Cancer Reference Information
American Cancer Society website
http://www.cancer.org/eprise/
main/docroot/CRI/
content/CRI_2_4_1X_What_are
_the_key_statistics_for_
salivary_gland_cancer_54?
sitearea=CRI
|
As of 2001
|
|
|
|
Distant Metastasis Rates in Parotid Carcinomas by Histology:
Acinic Cell Carcinoma: 2/14 (14%)
|
Cancer
Medicine, 5th Edition
Bast, Robert
C.; Kufe, Donald W.; Pollock, Raphael E.; Weichselbaum, Ralph R.; Holland,
James F.; Frei, Emil, editors.
Publisher:
Canada: BC Decker Inc;
Copyright
2000.
Section 27: Neoplasms of the Head and
Neck
86. Head and
Neck Cancer Treatment
|
2000
|
|
14
|
|
NOTE:
The National Cancer Data Base (NCDB) report provides the largest series of
acinic cell carcinoma cases
reviewed to date.
(below)
|
NOTE: The National Cancer Data Base
(NCDB) report provides the largest series of acinic cell carcinoma cases
reviewed to date.
|
|
|
|
|
Salivary gland cancers
comprise between 0.3% and 0.9% of all cancers in the United States. Acinic cell carcinomas account for
approximately 5% to 11% of these salivary gland cancers.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report). Published
: Head and Neck July 1999.
Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A.
Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
The largest series of
salivary gland tumors to date comes from the Armed Forces Institute of
Pathology (AFIP) Salivary Gland Registry, which identified acinic cell
carcinoma as the third most common epithelial malignancy of the salivary
glands. In the series,
acinic cell carcinoma represented 17% of primary malignant salivary gland
neoplasms, and 6% of all (including benign) salivary gland neoplasms.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma.
REFERENCING:
Armed Forces Institute of
Pathology Salivary Gland Registry
|
Accepted Aug. 27,
1998. Published July 1999.
|
unclear
|
unclear
|
|
Overall, survival has
been crudely estimated to be
about 84%. Reported 5-year determinant (disease specific) survival ranges
from 76% to 90%. These survival analyses should also be interpreted with the
understanding that 10 to 20 years of follow-up is needed to identify the full
impact of ACC on extended survival. Their study showed five-year survivalwas
83.3% (observed) and 91.4% (disease specific). Worse survival was associated with high grade
(p<.0001), age greater or equal to 30 years (p=.0055), and the presence of
metastatic disease (p<.0001).
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
STATISTICS
|
SOURCE
|
PUBLICATION DATE
|
TIME PERIOD STUDIED
|
# OF PATIENTS IN STUDY
|
|
The indolent behavior is
underscored by reports that recurrent tumor has been identified up to 30
years after initial treatment.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
|
|
|
Previous Demographics:
Most reports have identified that acinic cell carcinoma presents at an
earlier age than other salivary gland cancers and affects women more commonly
than men.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
|
|
|
Demographics: Income grouping reflected a
disproportionately large number of cases in the high income group (12.3%)
relative to the low income group (8.2%). Cases were predominantly white non-Hispanic (86.0%). Acinic cell carcinoma was more common
in women (58.8%) than in men (41.2%) in a consistent manner across both the
earlier period (1985-1990) and the later period (1991-1995). The median age at diagnosis for both
periods was approximately 52 years, with 16.2% of cases identified among
patients younger than 30 years.
Women comprised a significantly larger proportion of patients in this
younger group (64.4%) than in the older group (57.7%) (p=.0352).
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Tumor Characteristics:
The tumors arose in the parotid gland in 1167 cases (86.3%) and the
submandibular gland in 37 cases (2.7%). 26 cases (1.9%) were recorded as
arising within the major salivary glands, but without a specific gland
identified. Only one case was
identified as arising in the sublingual gland. The remaining 122 cases (9.0%) arose in sites other than
the major salivary glands, which presumably reflect involvement of the minor
salivary glands.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Tumor Characteristics: The
parotid gland , which is
dominated by serous cells and is the largest of the major salivary glands, is
also the most common site of acinic cell carcinoma. Acinic cell carcinomas are distinctly less common in the
mixed serous and mucous submandibular and sublingual glands and in the
predominantly mucous minor salivary glands.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Tumor Characteristics: Although serous-type cells do
not necessarily predominate in all cases, acinic cell carcinomas are commonly
characterized by cytologic differentiation toward the serous acinar cells.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Extent of Disease:
The median tumor size at the time of diagnosis was 2.0 cm.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Extent of Disease:
Among cases submitted by hospitals using the 3rd and 4th
editions of the AJCC staging manual: Approx. 2/3 (67.4%) of cases were Stage
I. The remainder were
distributed between stage II (14.4%), stage III (11.0%), and stage IV (7.1%).
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Extent of Disease:
There was insufficient data to assign extent of disease by the modified TNM
classifications (ie. classified as either local, regional or distant) for
66.7% of cases. At the time of
initial presentation, disease was confined locally (Any T, N0, M0) for 88.0%
of the patients who were classified by this system. Regional metastasis (Any T, N0, M0) was identified in 9.9%
of patients, and distant metastasis (Any T, Any N, M1) was identified in 2.1%
of patients.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
STATISTICS
|
SOURCE
|
PUBLICATION DATE
|
TIME PERIOD STUDIED
|
# OF PATIENTS IN STUDY
|
|
Extent of Disease:
Among patients for whom the modified TNM classification was known, local
confinement was more commonly recorded in the later period (1991-95) (89.5%) than in the earlier
period (1985-9)(85.2%), whereas
regional spread was more commonly recorded in the 1985-90 period (11.6%) than
in the 1991-95 period (9.0%).
This shift more likely reflects an artifact in the recording of
information than an actual change in the tumor behavior. The percentage of patients with
unknown TNM classification decreased across these years, from 39.2% to 12.1%,
and the majority of cases that were previously unknown (due to unknown
metastatic status) were probably recorded as locally confined (ie. known to
have no metastasis) in the 1991-1995 period.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Extent of Disease:
A significant association was identified between the extent of detectable disease and patient age.
Regional metastases, distant metastases, and large tumor size were all more
common among patients 30 years of age and older (p=.0015).
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Extent of Disease: Differences
in case distribution according to sex were also significant (p =.0481).
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Extent of Disease: There
were regional differences in the distribution of cases by extent of disease
as well. Regional metastases
were more common among cases in the South (15.7%) and Pacific (14.0%) regions
compared with the Northeast (2.4%) and Mountain (no cases) regions.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Extent of
Disease: There were no
significant associations between extent of disease and race (p=.8739), income
(p=.3433), and anatomic site (p=.3697).
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Grade: Although
the majority (67.6%) of cases were not assigned a degree of differentiation,
the proportion that were graded increased from 28.3% in the earlier period to
35.6% in the later period. Among
those cases with a recorded grade, grade 1 (57.8%) was most common and grade
4 (4.6%) was least common.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Grade: Higher
grade cancers were significantly associated with age 30 years or greater
(p=.0024), advanced stage (p=.0002), and the presence of metatatic disease at
presentation (p<.0001). There
was no association between grade and sex (p=.3061), income level (p=.4970),
or region (p=.3224). Among those
cases without regional or distant metastases, there was no association
between grade and tumor size analyzed by segregating cases as greater than or
less than 4.0 cm (p=.1248).
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Treatment: Single modality treatment with
surgery was employed in 64.0% of cases.
This proportion did not change appreciably between the earlier period
(1985-90) and the later period
(1991-95). Surgery with radiotherapy was employed in 30.1% of cases. Chemotherapy was used as adjuvant
therapy along with surgery or radiotherapy in 1.0% of cases. Among patients receiving treatment of
known type, surgery (alone or with adjuvant therapy) was employed in 1285 of
1345 cases (95.0%).
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Surgery: The method of coding surgical
resection did not permit analysis of extent of resection of the primary
cancer. The proportion of cases
receiving a cervical lymphadenectomy remained constant, at approximately 12%
across both time periods.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Lymph Nodes were
confirmed as positive for metatatic disease in 36.3% of the 135 patients who
were recorded as having a neck dissection with nodes examined. Among the 448 patients identified as
not receiving a lymph node dissection, 65 cases (14.5%) were identified with
positive lymph nodes in the surgical specimen. The reported incidence of regional nodal
involvement may be influenced both by the availability of advanced imaging
such as computed tomography (CT) and magnetic resonant imaging (MRI), as well
as the criteria used to identify nodal metastases.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Metastases: Some
series report an incidence of metastases at presentation, whereas others identify an overall
metastatic rate which includes recurrent cancers. Spafford et al broadly reported cervical lymohadenopathy
to be present in 10% to 15% of cases of acinic cell carcinoma. Spiro et al in a report of 67 cases
of acinic cell carcinoma treated before 1968 identified five cases (7.5%)
with cervical metastases at the time of initial treatment. An additional 6 patients were
identified with subsequent cervical metastases, for a total of 11 cases (16%) with regional
metastases. The higher incidence
of cervical metastases (9.9%) identified in our study may reflect early
detection of subclinical nodal disease through improved radiographic imaging
with CT and MRI. Lewis et al in
another study which accrued its last patient in 1978, identified an overall
regional metastatic rate of 11%, occurring either at presentation or as a
recurrence among 42 patients with a median follow-up of 11 years. Among this same group of patients,
distant metastases were ultimately identified in 13%.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma .
REFERENCED ARTICLES:
Spafford PD, Mintz DR,
Hay J. Acinic Cell Carcinoma of the parotid gland: review and management.
Journal of Otolaryngology 1991;20:262-266.
Spiro RH, Huvos AG,
Strong EW. Acinic cell carcinoma
of salivary origin; a clinicopathologic study of 67 cases. Cancer 1978; 41: 924-935.
Lewis JE,Olsen KD,
Weiland LH. Acinic cell
carcinoma: clinicopathologic review.
Cancer 1991;67: 172-179.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
and earlier in referenced
papers
|
1353
|
|
Treatment
Demographics: Chi square
analysis identified a significant association between treatment type and age
(p=.0011). Patients younger than
30 years of age were more commonly treated without adjuvant radiotherapy than
patients 30 years or older. The
demographic variables of sex and income did not show statistically
significant associations with specific treatment types.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Treatment: Although
treatment type differed for the various anatomic sites, the number of cases
arising in several individual sites was too small to permit statistical
analysis.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Treatment: Advanced
stage (p<.0001) and grade (p<.0001) were highly associated with the
more common use of surgery and radiotherapy, when compared with lower stage
and grade, which were most commonly treated with surgery alone.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Treatment: Surgical
treatment resulting in microscopic or macroscopic residual disease was more
commonly treated with adjuvant radiotherapy than when surgical margins were
negative (p<.0001).
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
|
Accepted Aug. 27,
1998. Published July 1999.
|
1985-1995
|
1353
|
|
Treatment:
The NCDB identifies that,
across the United States, the majority of cases of acinic cell carcinoma that
have either positive surgical margins, high grade, or neck metastases
received radiotherapy postoperatively.
Tumor size greater than 4 cm did not impact on the proportion of cases
treated with radiotherapy in our series. Other factors such as deep lobe involvement, recurrent
tumor, and extraparotid have been employed as criteria to treat with
postoperative radioatherapy, but were not available for evaluation in this
study.
The type of operation performed at the primary
site for salivary gland cancers is coded in the NCDB as either a local or
radical excision. As a result,
this report does not contain information regarding facial nerve sacrifice and
extent of parotid tissue resection.
It is clear from reports of salivary gland cancer treated in the
remote past that recurrence and survival is compromised when treatment is
limited to excision by enucleation.
Unfortunately, detailed analysis of the impact of extent of surgery on
outcome is usually confounded by a significant selection bias wherein extent
of disease determines the type of surgical treatment. Spiro et al identified that, among 67
cases of acinic cell carcinoma, the best results were observed in patients
receiving conservative operations.
These investigators concluded that outcome was more dependent on the
extent of the tumor than the type of operation performed.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
REFERENCED ARTICLE:
Spiro RH, Huvos AG,
Strong EW. Acinic cell carcinoma
of salivary origin; a clinicopathologic study of 67 cases. Cancer 1978; 41: 924-935.
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Accepted Aug. 27,
1998. Published July 1999.
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1985-1995
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1353
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STATISTICS
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PUBLICATION DATE
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TIME PERIOD STUDIED
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# OF PATIENTS IN STUDY
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The incidence of lymph node involvement ranges from 7% to 16%
for acinic cell carcinoma. Acinic cell carcinomas represent only 2.5% to 7.0%
of all parotid epithelial tumors and 12.5% of parotid gland carcinomas.
Furthermore, the incidence of acinic cell carcinoma involving the
parapharyngeal space is rare, with only 7 reported cases (to our knowledge)
in the world literature.8 The vast majority of
acinic cell carcinomas arise in the parotid gland, although they may rarely
be found in other major salivary glands or in the seromucous glands of the
upper aerodigestive tracts. Acinic cell carcinoma is the most likely of
salivary gland carcinomas to occur bilaterally. Most acinic cell carcinomas
will present in the fourth to sixth decades of life but have been known to
occur in the elderly and in children, ranking second in incidence to
mucoepidermoid carcinoma of the parotid gland in children aged 12 years or
younger.9 The male-female ratio
for this tumor has been quoted as ranging from 1:1 to 1:2.
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Archives
of Otolaryngology Head and Neck Surgery: Vol. 125 No. 6, June 1999
Also online at: http://archotol.ama-assn.org/
issues/v125n6/ffull/orp0699-1b.html
Referencing: 8. Yokoyama M, Nomura Y,
Semba T. Acinic cell carcinoma of the parapharyngeal space: case report. Head
Neck.
1993;15:67-69.
9. Perzin KH, LiVolsi VA. Acinic cell carcinomas arising in
salivary glands: a clinicopathologic study. Cancer. 1979;44:1434-1457.
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June, 1999
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Acinic cell carcinoma has a low incidence of lymph node
metastasis; therefore, neck dissection is reserved for management of
clinically suspicious nodes.9 Postoperative
radiotherapy is recommended for cases with residual disease.8 The recurrence rate
for these tumors has been reported as ranging from 30% to 50%, with a distant
metastasis rate of 7% to 29%.10 Late recurrences (after 20 years or more) are common, and
in such cases, additional surgery is the treatment of choice. The 5-, 10-,
and 20-year-survival rates are reportedly 90%, 83%, and 67%, respectively.10
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Archives
of Otolaryngology Head and Neck Surgery: Vol. 125 No. 6, June 1999
Also online at: http://archotol.ama-assn.org/
issues/v125n6/ffull/orp0699-1b.html
Referencing: 8. Yokoyama M, Nomura Y,
Semba T. Acinic cell carcinoma of the parapharyngeal space: case report. Head
Neck.
1993;15:67-69.
9. Perzin KH, LiVolsi VA. Acinic cell carcinomas arising in
salivary glands: a clinicopathologic study. Cancer. 1979;44:1434-1457.
10. Lewis JE, Olsen KD, Weiland LH. Acinic cell carcinoma:
clinicopathic review. Cancer. 1991;67:172-179
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June, 1999
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In 71% of the ACC patients, painful
swelling of the lateral region of the face was the main symptom. Facial
paralysis occurred in 11% of cases before treatment. Tumor recurrence after
therapy was noted in 42% of cases.
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Retrospective
analysis of 35 patients with acinic cell carcinoma of the parotid gland.
Laskawi R,
Rodel R, Zirk A, Arglebe C.
ENT
Department, University of Gottingen, Germany.
J Oral
Maxillofac Surg 1998 Apr;56(4):440-3
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April, 1998
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Check full text
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35
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Highly differentiated ACC was the most
frequent histologic subtype (74%). The grade of differentiation of the tumor
was decisive for the prognosis. Highly differentiated ACC had a better
prognosis (2 years overall survival, 100%; 5 years overall survival, 83%; 10
years overall survival, 50%) than lowly differentiated tumors (2 years
overall survival, 70%; 5 years overall survival, 50%; 10 years overall
survival, 30%).
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Retrospective
analysis of 35 patients with acinic cell carcinoma of the parotid gland.
Laskawi R,
Rodel R, Zirk A, Arglebe C.
ENT
Department, University of Gottingen, Germany.
J Oral
Maxillofac Surg 1998 Apr;56(4):440-3
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April, 1998
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Check full text
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35
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Classification of
Salivary Gland Tumors:
Foote and Frazell classify ACC as ³malignant².
Thackary and Lewis classify ACC as ³malignant².
Armed Forces Institute of Pathology classifies
it as a ³malignant
adenocarcinoma².
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SALIVARY GLAND TUMORS;
CLINICAL AND PATHOLOGICAL FEATURES
S Tabibzadeh
BioScience.org - FRONTIERS IN BIOSCIENCE; LECTURE SERIES
[Vol 3,
z1-129, January 1, 1998]
Dept of
Pathology, Moffitt Cancer Center and University of South Florida, 12902
Magnolia Drive, Tampa, FL 33612
http://www.bioscience.org/lecture/
tabibza/list.htm
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Jan. 1 1998
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STATISTICS
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Recurrence: Of the 1985-1990 patients with
details recorded addressing recurrence (n=201, or 34.0%) 56 were identified
with recurrent or persistent disease, 32 of who were alive at the time of
last follow-up. (more details in
article)
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National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
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Accepted Aug. 27,
1998. Published July 1999.
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1985-1995
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1353
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Survival: Sufficient informationwas available
from the 1985-90 period for overall observed survival to be calculated for
585 patients and disease specific
survival for 549 patients.
Five year disease-specific survival was 91.4% and observed survival
was 83.3%. Significant
associations were identified between worse disease-specific survival and
higher grade (p<.0001), regional or distant metastases at presentation
(p<.0001), site of cancer in the submandibular gland (p=.0091) , and age
of 30 years or greater (p=.0055).
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National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report). Published
: Head and Neck July 1999.
Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD, Robert A.
Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
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Accepted Aug. 27,
1998. Published July 1999.
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1985-1995
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1353
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Survival: Survival analysis according to
initial treatment showed that surgery with out adjuvant therapy was
associated with the best 5 year survival (96.8%). This outcome was significantly better than the 88.2% 5
year survival identified following combined treatment with surgery and radiotherapy
(p=.0004). To compensate for the
bias which usually directs use of combined modality management to cancers
with worse prognosis, treatment outcome was separately analyzed for patients
with high grade disease, regional spread, and microscopically positive
surgical margins. Among
high-grade cancers (grade 3 and 4), the addition of radiotherapy to surgery
resulted in a better survival for those 14 cases receiving combined modality
therapy (41.5%), compared with the nine cases treated with surgery only
(29.2%). The difference was not
statistically significant (p=.5329).
In contrast, surgery alone resulted in better survival than surgery
combined with radiotherapy, among the 44 patients with regional spread of
disease and the 38 patients with microscopic residual disease following
surgery. These differences
were not statistically significant (p=.1561 and p=.1835 respectively). Further analysis identified that
despite this segregation of cases into these three individual groups, other
prognostic variables were not randomly distributed between the cases treated
with and without adjuvant radiotherapy.
As a result, direct comparisons cannot be made between groups treated
with and without radiotherapy. ACCIC
authorıs note: This data does
not distinguish or even address the difference between conventional and fast
neutron radiotherapy.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
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Accepted Aug. 27,
1998. Published July 1999.
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1985-1995
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1353
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ACC Outcome:
Acinic cell carcinoma has been identified as the least aggressive of the salivary
gland cancers. From a review of
multiple reports, the most recent AFIP fascicle addressing salivary gland
cancer identifies the overall recurrence rate for acinic cell carcinoma to be
35%. These investigators
identified that death from persistent or recurrent disease occurred in
16%. Other reports have
identified similar statistics, with the observation that prolonged survival
despite persistence of disease is possible. The prolonged survival that may occur despite persistent
disease appears to support the practice
of managing incurable disease with aggressive treatment as needed for
palliation. Disease
characteristics reported to indicate a poor prognosis include location of
tumor in the deep lobe of the parotid gland and presence of infiltrative
margins, presumably because these factors influence completeness of
excision. The current results
demonstrate that incomplete excision is associated with a lower chance of
survival. .. Overall survival was best for cases characterized by younger age
and lower stage.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
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Accepted Aug. 27,
1998. Published July 1999.
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1985-1995
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1353
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ACC Overview
Conclusion: Survival was
best for cases characterized by younger age and lower stage. Although better outcome was not
statistically demonstrated for cases treated with combined therapy, surgery
with radiotherapy is the most common management for cases with regional
metastases, grades 3 or 4, and microscopic positive margins. The clear association identified
between higher grade and aggressive behavior supports the wider application
of a standardized approach to grading acinic cell carcinoma.
|
National Cancer Data Base
Report on Cancer of the Head and Neck: Acinic Cell Carcinoma
(multi-institution report).
Published : Head and Neck July 1999. Authors: Henry T. Hoffman MD, Lucy Hynds Karnell PhD,
Robert A. Robinson, MD, John A. Pinkston MD, Herman R. Menck MBA.
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Accepted Aug. 27,
1998. Published July 1999.
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1985-1995
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1353
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The majority of tumors were located
in the parotid gland and were Stage I at presentation. There was a female
predominance and the mean age at primary diagnosis was 51.2 years for females
and 41.0 for males. The solid-acinar cell pattern was the most frequently
observed and the tumors were 'diploid' in all the six cases studied.
Surgery was the therapeutic modality
in all cases (enucleation in seven, superficial parotidectomy in three and
total parotidectomy in five) and, in four of them, was complemented with
radiotherapy. The clinical course was characterized by recurrence in 10 cases,
metastases occurred in three patients and one patient died of the tumor. Of
the seven recurrent cases, six were treated by enucleation and one by
superficial parotidectomy.
The histological pattern showed no correlation with the
clinical course or DNA content.
Acinic cell carcinoma has a significant morbidity with a
high recurrence rate which seems to be largely influenced by the type of
surgery employed. Wide surgical
excision of the neoplasia, which includes total parotidectomy in the parotid
cases, is recommended in order to reduce the frequency of recurrence of the
tumor.
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Acinic cell
carcinoma of the salivary glands. A long term follow-up study of 15 cases.
Oliveira P,
Fonseca I, Soares J.
Servico de
Patologia Morfologica, Instituto Portugues de Oncologia de Francisco
Gentil-Centro de Lisboa.
Eur J Surg
Oncol 1992 Feb;18(1):7-15
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1992 Feb
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15
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STATISTICS
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PUBLICATION DATE
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TIME PERIOD STUDIED
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The
majority of the tumors (92.8%) were located in the parotid gland.
Two thirds
of the patients were female; one third were male.
Mean age at
primary diagnosis was 55.4 years.
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Acinic cell carcinoma of the salivary glands: the
prognostic relevance of DNA cytophotometry in a retrospective study of long
duration (1965-1987).
Hamper K,
Mausch HE, Caselitz J, Arps H, Berger J, Askensten U, Auer G, Seifert G.
Institute
of Pathology, University-Hospital Hamburg-Eppendorf, West Germany.
Oral Surg
Oral Med Oral Pathol 1990 Jan;69(1):68-75
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Jan. 1990
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1965-1987
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55 (?)
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The tumors
were graded into highly differentiated (76%) or less differentiated forms
(24%) according to classic histologic and cytologic criteria.
The
clinical course was characterized by no recurrence in 15 cases; in 17 cases,
recurrences developed, and 12 patients died of their tumor, some as late as
240 months after primary diagnosis.
Differentiation
showed a weak correlation with the clinical course.
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Acinic cell carcinoma of the salivary glands: the
prognostic relevance of DNA cytophotometry in a retrospective study of long
duration (1965-1987).
Hamper K,
Mausch HE, Caselitz J, Arps H, Berger J, Askensten U, Auer G, Seifert G.
Institute
of Pathology, University-Hospital Hamburg-Eppendorf, West Germany.
Oral Surg
Oral Med Oral Pathol 1990 Jan;69(1):68-75
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Jan. 1990
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1965-1987
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55 (?)
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The tumors
were "diploid" or "near-diploid" in 34 cases; DNA content
showed no correlation to the clinical course.
As a result
of long-term follow-up, it becomes evident that acinic cell carcinoma is
prone to develop recurrences and metastases.
Complete
tumor removal during the primary operation seems to be important for
controlling the disease inasmuch as the ostensible prognostic predictors
evaluated here proved to be unreliable.
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Acinic cell carcinoma of the salivary glands: the
prognostic relevance of DNA cytophotometry in a retrospective study of long
duration (1965-1987).
Hamper K,
Mausch HE, Caselitz J, Arps H, Berger J, Askensten U, Auer G, Seifert G.
Institute
of Pathology, University-Hospital Hamburg-Eppendorf, West Germany.
Oral Surg
Oral Med Oral Pathol 1990 Jan;69(1):68-75
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Jan. 1990
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1965-1987
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55 (?)
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The 25 year
determinate survival rate is 50 per cent, with a 20 per cent incidence of
metastasis.
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Acinic cell
carcinoma of minor salivary gland origin.
Hutchinson JC
Jr.
Am J
Otolaryngol 1981 Feb;2(1):54-8
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Feb. 1981
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Check full text
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Check full text
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STATISTICS
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SOURCE
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TIME PERIOD STUDIED
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# OF PATIENTS IN STUDY
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The tumor
arose in the parotid gland in 64 patients, the submaxillary gland in one and
minor salivary glands in two.
In
untreated patients with small tumors, clinical findings usually suggested a
benign mixed tumor and a subtotal parotidectomy which spared the facial nerve
was highly effective therapy.
In contrast, local recurrence and death was the rule in
those few who had locally extensive disease, regardless of how radical an
operation was performed.
Determine "cure" rates for the entire group
were 76, 63 and 55% at 5, 10 and 15 years, respectively. Cervical lymph node
metastasis occurred in 16% of the patients, and distant metastasis in 12%.
Survival
was most directly influenced by the clinical extent of the primary tumor, and
also correlated with certain histologic features which are described.
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Acinic cell
carcinoma of salivary origin.
A
clinicopathologic study of 67 cases.
Spiro RH,
Huvos AG, Strong EW.
Cancer 1978
Mar;41(3):924-35
Abstract
GET FULL TEXT
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March 1978
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67
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