Total pancreatectomy for metachronous mixed acinar-ductal carcinoma in a remnant pancreas

Abstract

In October 2009, a 71-year-old female was diagnosed with a cystic tumor in the tail of the pancreas with an irregular dilatation of the main pancreatic duct in the body and tail of the pancreas. A distal pancreatectomy with splenectomy, and partial resection of the duodenum, jejunum and transverse colon was performed. In March 2011, a follow-up computed tomography scan showed a low density mass at the head of the remnant pancreas. We diagnosed it as a recurrence of the tumor and performed a total pancreatectomy for the remnant pancreas. In the histological evaluation of the resected specimen of the distal pancreas, the neoplastic cells formed an acinar and papillary structure that extended into the main pancreatic duct. Mucin5AC, α1-antitrypsin (α-AT) and carcinoembryonic antigen (CEA) were detected in the tumor cells by immunohistochemistry. In the resected head of the pancreas, the tumor was composed of both acinar and ductal elements with a mottled pattern. The proportions of each element were approximately 40% and 60%, respectively. Strongly positive α-AT cells were detected in the acinar element. Some tumor cells were also CEA positive. However, the staining for synaptophysin and chromogranin A was negative in the tumor cells. Ultimately, we diagnosed the tumor as a recurrence of mixed acinar-ductal carcinoma in the remnant pancreas. In conclusion, we report here a rare case of repeated pancreatic resection for multicentric lesions of mixed acinar-ductal carcinoma of the pancreas.

A Pediatric Case of Mixed Acinar-Neuroendocrine Carcinoma

“…Of these, 17 cases had pancreatic masses classified as MANEC or mixed acinar ductal carcinoma [1][2][3][12][13][14][15]. In those reports, which included 5 female and 12 male patients, the mean patient age was 65.6 years and the mean mass size was 4.0 cm, with an unreported mass size in 1 case.…”

Mixed ductal-acinar cell carcinoma of the pancreas: A case report

“…Mixed ductal-acinar cell carcinoma is extremely rare, with only 21 cases reported in the English and Japanese literature to date (4)(5)(6)(7)(8)(9)(10), and its clinicopathological characteristics have not been clearly determined thus far. The current study herein describes our experience with a case of mixed ductal-acinar cell carcinoma in a 74-year-old male patient and discuss the relevant literature.…”