1. KCP 810 울산대학교 서울아산병원 병리과 전공의 송인혜

2. 환자 병력 40 세 / 여자 17 년 전 오른쪽 이하선 종양으로 부분절제 8 년 전 전절제, 방사선 치료 이후 재발 및 재수술 반복 경부 MRI 및 PET: 오른쪽 빗장위림프절 전이 의심 림프절 세포흡인검사 및 결절 제거

8. Differential Diagnoses Adipocytic tumor –Round cell liposarcoma –Lipoblastoma Salivary gland tumor –Clear cell carcinoma –Acinic cell carcinoma –Mammary analogue secretory carcinoma

9. Clear cell carcinoma Mean age: 6 th decade (Range: 24-78 yrs), F > M (1.2:1) Minor salivary glands predominant (~ 80%) Background clean Uniform, round to oval eccentric nuclei with smooth membrane and granular chromatin Clear, pale, bubbly or vacuolated cytoplasm Medium-sized, round, oval, or cuboidal cells Prominent nucleoli Groups and sheets of cohesive epithelial cells

10. Acinic cell carcinoma Wide age range (mean: mid 40s), F > M (3:2) Parotid gland most common Usually very cellular Strong resemblance to normal acinar cells Cytoplasmic zymogen granules (at least focal) Acinar, trabecular or papillary pattern Abundant, granular, vacuolated or clear cytoplasm Enlarged nuclei with granular chromatin, prominent nucleoli

11. Mammary analogue secretory carcinoma First described in 2010, unlisted in the WHO blue book t (12;15)(p13;q25): ETV6-NTRK3 fusion Average age 45.7 yrs, M > F (1.4:1) Parotid gland most common (~ 2/3) Clean background, hypercellular smear Sheet-like or papillary architecture, singly dispersed cells Cuboidal, spindle to bipolar or polygonal cells Round to oval uniform nuclei with small nucleoli Vacuolated cytoplasm with pale green secretory material

15. Mammary analogue secretory carcinoma

16. References Kini, Sudha R. Color atlas of differential diagnosis in exfoliative and aspiration cytopathology. 2 nd ed. 2011. Thompson, Lester D. R. Diagnostic pathology. Head and neck. Takeda M. et al. Cytopathological Features of Mammary Analogue Secretory Carcinoma—Review of Literature. Diagnostic Cytopathology. 2014. Higuchi K. et al. Cytological Features of Mammary Analogue Secretory Carcinoma of Salivary Gland: Fine-Needle Aspiration of Seven Cases. Diagnostic Cytopathology. 2014. Chiosea S. I. et al. Clinicopathological characterization of mammary analogue secretory carcinoma of salivary glands. Histopathology. 2012.