Hiyoshi Masahide, Kai Kengo, Hamada Takeomi, Yano Koichi, Imamura Naoya, Nanashima Atsushi
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, University of Miyazaki, Faculty of Medicine, Miyazaki, Japan.
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, University of Miyazaki, Faculty of Medicine, Miyazaki, Japan.
Int J Surg Case Rep. 2022 May;94:107091. doi: 10.1016/j.ijscr.2022.107091. Epub 2022 Apr 18.
Acinar cell carcinoma (ACC) of the pancreas is a rare pancreatic cancer subtype (incidence, 0.5-2%) with unclear epidemiology and prognosis. Sometimes, repeat resection including total pancreatectomy is required for recurrence. We report a case of ACC recurring in the remnant pancreatic head after distal pancreatectomy that was successfully cured by remnant pancreatic resection following combination therapy with nab-paclitaxel (nab-PTX) and gemcitabine (GEM).
A 64-year-old woman was referred for pancreatic tumour treatment. CT revealed a 46-mm tumour in the pancreatic body, and endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) indicated ACC. Distal pancreatectomy was performed, and the final diagnosis was ACC. CT 18 months later showed a 34-mm tumour in the remnant pancreatic head revealed as ACC by EUS-FNA. Portal vein invasion was apparent, so neoadjuvant chemotherapy with nab-PTX and GEM was administered, and remnant pancreatic resection (total pancreatectomy) was performed. No recurrence or distant metastasis was present more than 6 months later.
Mean survival time for ACC is 18-47 months, and prognosis is good compared with pancreatic ductal adenocarcinoma (PDAC). ACC tends to extend and grow along the main pancreatic duct, which increases the recurrence rate to 50-60%. EUS and EUS-FNA were useful for evaluating tumour extension and diagnosis. Repeat pancreatic resection that included total pancreatectomy was feasible and could be performed safely.
ACC has a better prognosis than PDAC but with a higher recurrence rate. Aggressive surgical resection that included remnant total pancreatotomy with chemotherapy was useful in treating ACC.
胰腺腺泡细胞癌（ACC）是一种罕见的胰腺癌亚型（发病率为0.5%-2%），其流行病学和预后尚不清楚。有时，复发时需要进行包括全胰切除术在内的再次切除。我们报告一例在胰体尾切除术后胰头残端复发的ACC病例，该病例在接受纳米白蛋白结合型紫杉醇（nab-PTX）和吉西他滨（GEM）联合治疗后通过残胰切除术成功治愈。
一名64岁女性因胰腺肿瘤治疗前来就诊。CT显示胰体有一个46毫米的肿瘤，内镜超声引导下细针穿刺抽吸（EUS-FNA）提示为ACC。行胰体尾切除术，最终诊断为ACC。18个月后的CT显示胰头残端有一个34毫米的肿瘤，EUS-FNA显示为ACC。门静脉侵犯明显，因此给予nab-PTX和GEM新辅助化疗，并进行了残胰切除术（全胰切除术）。6个月后未出现复发或远处转移。
ACC的平均生存时间为18-47个月，与胰腺导管腺癌（PDAC）相比预后较好。ACC倾向于沿主胰管延伸和生长，这使得复发率增加到50%-60%。EUS和EUS-FNA有助于评估肿瘤的延伸和诊断。包括全胰切除术在内的再次胰腺切除是可行的，并且可以安全进行。
ACC的预后比PDAC好，但复发率较高。积极的手术切除，包括残胰全切除术联合化疗，对治疗ACC有效。
