Jimbo Masaya, Batista Philip M, Baliff Jeffrey P, Yeo Charles J
Department of Surgery, Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Case Rep Pancreat Cancer. 2016 Jun 1;2(1):46-49. doi: 10.1089/crpc.2016.0009. eCollection 2016.
Acinar cell carcinoma is a rare form of pancreatic cancer, accounting for 1-2% of all cases of exocrine pancreatic neoplasms in adults. Due to its rarity, no randomized controlled trials have been performed to determine the optimal treatment options. As such, high-quality case reports and case series are needed to help guide clinicians in the management of this deadly disease. A 56-year-old Caucasian male presenting with abdominal pain and weight loss was diagnosed with stage III acinar cell carcinoma of the pancreatic body with celiac axis involvement. Although initially deemed unresectable, the patient responded favorably to nine cycles of 5-fluorouracil-based neoadjuvant chemotherapy. The tumor was successfully resected through distal pancreatectomy with splenectomy and celiac artery resection (Appleby procedure). Final pathology analysis showed negative resection margins and complete chemotherapeutic response within the pancreas, with residual tumor cells detected in only a single peripancreatic lymph node. 5-fluorouracil-based chemotherapy may be a promising option for the neoadjuvant treatment of locally unresectable acinar cell carcinoma. With sufficient expertise, negative surgical resection margins are possible even with vascular involvement. Due to the generally poor prognosis associated with acinar cell carcinoma, such aggressive treatment measures are warranted.
腺泡细胞癌是一种罕见的胰腺癌，占成人外分泌性胰腺肿瘤所有病例的1%至2%。由于其罕见性，尚未进行随机对照试验来确定最佳治疗方案。因此，需要高质量的病例报告和病例系列来帮助指导临床医生管理这种致命疾病。一名56岁出现腹痛和体重减轻的白种男性被诊断为胰体III期腺泡细胞癌，伴有腹腔干受累。尽管最初认为无法切除，但该患者对基于5-氟尿嘧啶的新辅助化疗九个周期反应良好。通过胰体尾切除术、脾切除术和腹腔干动脉切除术（阿普尔比手术）成功切除肿瘤。最终病理分析显示切缘阴性，胰腺内化疗反应完全，仅在一个胰周淋巴结中检测到残留肿瘤细胞。基于5-氟尿嘧啶的化疗可能是局部无法切除的腺泡细胞癌新辅助治疗的一个有前景的选择。凭借足够的专业知识，即使有血管受累，也有可能实现阴性手术切缘。由于腺泡细胞癌总体预后较差，这种积极的治疗措施是必要的。
