Yokode Masataka, Itai Ryosuke, Yamashita Yukimasa, Zen Yoh
Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Medicine (Baltimore). 2017 Nov;96(45):e8534. doi: 10.1097/MD.0000000000008534.
Acinar cell carcinomas (ACCs) and mixed acinar-endocrine carcinomas (MAECs) of the pancreas are rare, accounting for only 1% of pancreatic tumors. Although both typically present at an advanced stage, chemotherapeutic regimes have not yet been standardized.
A 65-year-old man presented with a large mass in the pancreatic tail with multiple liver metastases.
DIAGNOSIS, INTERVENTIONS, OUTCOMES: He was initially treated with gemcitabine for suspected ductal carcinoma of the pancreas, but no response was observed. S-1, administered as second-line chemotherapy, showed an approximately 38% reduction in the size of the primary tumor and metastatic deposits with therapeutic effects being maintained for 12 months. When the tumor progressed again, he underwent a percutaneous liver biopsy, which led to the diagnosis of MAEC. Combination therapy with cisplatin and etoposide targeting the endocrine component was administered, and this was based on the endocrine component potentially being less sensitive to S-1 than the ACC element. However, therapy was stopped due to the development of neutropenia, and the patient is currently receiving best supportive care.
Given the previous studies suggested that S-1 is more effective for ACCs than gemcitabine, MAECs may also respond to S-1 chemotherapy, similar to ACCs. Another potential interpretation is that S-1 was effective when the condition was ACC, and eventually showed decreased effectiveness when the condition shifted to MAEC. Future studies are needed to conclude whether S-1 chemotherapy truly works against MAECs or induces endocrine differentiation in ACCs as a part of the drug-resistance process.
胰腺腺泡细胞癌（ACC）和腺泡-内分泌混合癌（MAEC）较为罕见，仅占胰腺肿瘤的1%。尽管这两种癌症通常在晚期出现，但化疗方案尚未标准化。
一名65岁男性，胰尾有一个大肿块并伴有多处肝转移。
诊断、干预措施及结果：他最初因疑似胰腺导管癌接受吉西他滨治疗，但未观察到疗效。作为二线化疗药物使用的S-1使原发肿瘤和转移灶大小缩小了约38%，且治疗效果维持了12个月。当肿瘤再次进展时，他接受了经皮肝穿刺活检，结果诊断为MAEC。基于内分泌成分可能比ACC成分对S-1敏感性更低，给予了针对内分泌成分的顺铂和依托泊苷联合治疗。然而，由于出现中性粒细胞减少症，治疗停止，患者目前正在接受最佳支持治疗。
鉴于先前的研究表明S-1对ACC的疗效优于吉西他滨，MAEC可能也会像ACC一样对S-1化疗产生反应。另一种可能的解释是，当病情为ACC时S-1有效，而当病情转变为MAEC时最终疗效降低。需要进一步的研究来确定S-1化疗是否真的对MAEC有效，或者在ACC中诱导内分泌分化是否是耐药过程的一部分。
