Large acinar cell carcinoma of the pancreas in a patient with elevated serum AFP level

Abstract

A pancreatic carcinoma, associated with elevated serum alpha-fetoprotein level, was resected from a 67-year-old man. The tumor was strongly suggested to be an acinar cell carcinoma of the pancreas, based on the histological findings of the resected specimen. The tumor measured 12 x 10 x 9 cm, and the cut surface was soft, whitish-yellow, focally necrotic, and hemorrhagic. Under a light microscope, the tumor cells were not arranged in a tubular and trabecular pattern, but rather, showed a tendency toward an acinar structure. Immunohistochemically, alpha 1-antitrypsin- and alpha 1-antichymotrypsin-positive reactions were diffusely positive in most of the tumor cells, while staining for chromogranin, neuron-specific enolase, Grimelius, glucagon, insulin, and alpha-fetoprotein was negative in the tumor cells. We report a large acinar cell carcinoma (associated with elevated serum alpha-fetoprotein level), which had been misdiagnosed as hepatocellular carcinoma preoperatively.

Aggressive approach to acinar cell carcinoma of the pancreas: a single-institution experience and a literature review

“…Upfront surgery is mostly used for resectable ACC. Neoadjuvant chemoradiation may be used for borderline resectable and locally advance ACC [12,13].…”

“…ACC may be associated with elevated serum levels of CEA and CA 19.9, and occasionally, with elevated serum AFP (4.5-6% of cases) [9][10][11][12][13].…”

Huge Pancreatic Acinar Cell Carcinoma with High Levels of AFP and Fucosylated AFP (AFP-L3)

“…One case was diagnosed as rupture of HCC (17). In the present case, both AFP and AFP-L3, which is known as a specific tumor marker for HCC (1, 2), were elevated, and elevation of the latter made it difficult to diagnose the huge tumor originating from the pancreas before the operation.…”

“…Only a small number of pancreatic acinar cell carcinoma (ACC) cases with elevation of AFP have been reported in literature (Table 1) (3-28). Moreover, only a small number of reports have documented lectin fractionation of AFP in ACC (8,17,21). We present a case of large pancreatic ACC accompanied by high levels of AFP and AFP-L3, which was difficult to diagnose prior to surgery.…”

Laparoscopic distal pancreatectomy of an acinar cell carcinoma

“…Because ACC of the pancreas is rare, a strategy for its management needs to be explored. Early diagnosis and resection remain the principal treatments, and other modalities of therapy, such as chemotherapy, remain unsatisfactory [2][3][4][5][6][7][8]. Although it was not statistically significant, an increased survival rate was noted among patients who underwent resection [9].…”