Hara Takeo, Fujiwara Yoshiyuki, Takahashi Hidenori, Sugimura Keijiro, Moon Jeong-Ho, Omori Takeshi, Miyoshi Norikatsu, Tomokuni Akira, Akita Hirofumi, Kobayashi Shogo, Yasui Masayoshi, Miyata Hiroshi, Ohue Masayuki, Sakon Masato, Tomita Yasuhiko, Yano Masahiko
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka City, Osaka, 537-8511, Japan.
Department of Diagnostic Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka City, Osaka, 537-8511, Japan.
Surg Case Rep. 2017 Dec;3(1):51. doi: 10.1186/s40792-017-0326-y. Epub 2017 Mar 30.
Pancreatic neoplasms are usually characterized by ductal, acinar, or endocrine differentiation. Mixed exocrine and endocrine pancreatic tumours are extremely rare. Here, we report a case of pancreatic mixed acinar-endocrine carcinoma (MAEC) with multiple synchronous liver metastases that were treated with surgery and transcatheter arterial chemoembolization (TACE) that later recurred in the stomach.
A 45-year-old female with severe anaemia was referred to our hospital. Computed tomography (CT) demonstrated a hypervascular tumour, 17 cm in diameter, that was in the tail of the pancreas. In addition, there were multiple hypervascular tumours in the liver. She underwent a distal pancreatectomy with splenectomy after the liver metastases were treated with TACE. Pathology confirmed that the pancreatic tumour was MAEC. After 4.5 years, a follow-up CT showed a hypervascular tumour at the upper part of the stomach. Gastric endoscopy showed a big tumefactive lesion with surface irregularities, gastric erosion, and multiple dilated vessels in the fornix and greater curvature of the stomach. She underwent a proximal gastrectomy and survived 7 years and 2 months after the start of the treatment.
This is the first report of a metastatic stomach tumour from pancreatic MAEC, which was successfully treated with a multidisciplinary approach. Additionally, we review the literature and discuss the treatment of MAEC.
胰腺肿瘤通常以导管、腺泡或内分泌分化为特征。胰腺外分泌和内分泌混合性肿瘤极为罕见。在此，我们报告一例胰腺混合性腺泡-内分泌癌（MAEC）伴多发同步肝转移的病例，该病例接受了手术和经动脉化疗栓塞术（TACE）治疗，随后肿瘤在胃内复发。
一名45岁重度贫血女性被转诊至我院。计算机断层扫描（CT）显示胰腺尾部有一个直径17厘米的富血管肿瘤。此外，肝脏内有多个富血管肿瘤。在对肝转移灶进行TACE治疗后，她接受了远端胰腺切除术加脾切除术。病理证实胰腺肿瘤为MAEC。4.5年后，随访CT显示胃上部有一个富血管肿瘤。胃镜检查显示胃穹窿部和胃大弯处有一个大的肿块样病变，表面不平整，胃黏膜糜烂，有多处扩张血管。她接受了近端胃切除术，治疗开始后存活了7年零2个月。
这是首例胰腺MAEC转移至胃的肿瘤病例，该病例通过多学科方法成功治疗。此外，我们回顾了文献并讨论了MAEC的治疗方法。
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