Kayahara Masato, Onishi Ichiro, Makita Naoki, Kano Shunsuke, Munemoto Masayoshi, Yagi Yasumichi, Minami Makiko, Orita Noriaki, Komura Takuya, Kurose Nozomu
Department of Surgery, NHO Kanazawa Medical Center, 1-1 Shimoishibikicho, Kanazawa, Ishikawa, 920-8650, Japan.
Department of Radiology, NHO Kanazawa Medical Center, 1-1 Shimoishibikicho, Kanazawa, Ishikawa, 920-8650, Japan.
Surg Case Rep. 2021 Apr 13;7(1):90. doi: 10.1186/s40792-021-01172-0.
Pancreatic acinar cell carcinoma (PACC) is a rare exocrine malignant tumor. Its widespread intraductal extension into the main pancreatic duct (MPD) is also rare.
We report the case of a 71-year-old man with PACC with MPD extension. The patient was assessed with laboratory and radiographic investigations that facilitated a preoperative diagnosis. Endoscopic ultrasonography (EUS) and dynamic thin-slice multi-detector row computed tomography (MDCT) were useful for determining the resection line of the pancreas. EUS-guided fine needle aspiration (EUS-FNA) was also helpful in determining the tumor biology and treatment strategy. Distal pancreatectomy was performed. The MPD was occupied by the tumor 35 mm downstream and 5 mm upstream. Histopathologically, the pancreatic tail tumor extended continuously into the MPD. The tumor was solid with cells showing eosinophilic and granular cytoplasm, indicating the diagnosis of PACC. This is an interesting case of PACC with intraductal extension into the MPD. We discuss the possible mechanisms of tumor extension in this rare case together with a review of the literature.
We describe a rare pancreatic acinar cell carcinoma that could be adequately treated using preoperative precise imaging and histopathological evaluations. When an intraductal tumor extension in the MPD is encountered, the diagnosis of a rare pancreatic tumor should be considered, as in our case.
胰腺腺泡细胞癌（PACC）是一种罕见的外分泌恶性肿瘤。其广泛的导管内延伸至主胰管（MPD）的情况也很罕见。
我们报告了一例71岁患有PACC伴MPD延伸的男性患者。通过实验室和影像学检查对患者进行评估，有助于术前诊断。内镜超声检查（EUS）和动态薄层多排探测器计算机断层扫描（MDCT）有助于确定胰腺的切除线。EUS引导下细针穿刺活检（EUS-FNA）也有助于确定肿瘤生物学特性和治疗策略。实施了远端胰腺切除术。肿瘤占据了MPD下游35毫米和上游5毫米的区域。组织病理学检查显示，胰尾肿瘤连续延伸至MPD。肿瘤为实性，细胞呈嗜酸性且胞质颗粒状，确诊为PACC。这是一例有趣的PACC伴导管内延伸至MPD的病例。我们结合文献复习讨论了这一罕见病例中肿瘤延伸的可能机制。
我们描述了一例罕见的胰腺腺泡细胞癌，通过术前精确的影像学和组织病理学评估可得到充分治疗。当遇到MPD内导管内肿瘤延伸时，应考虑罕见胰腺肿瘤的诊断，如我们的病例。
