Japanese Journal of Clinical Oncology 2006 36(7):473; doi:10.1093/jjco/hyl071
© 2006 Foundation for Promotion of Cancer Research
A Case of Acinar Cell Adenocarcinoma in the Pancreatic Tail
Yoshinori Yamada1 and
Nobuyoshi Hiraoka2
1 Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Central Hospital, Tokyo, Japan 2 Pathological Division, National Cancer Center Research Institute, Tokyo, Japan
A 46-year-old male, suffering from severe anaemia and abdominal distension, was referred to our institute in a diagnosis of huge ‘gastric’ tumour. Abdominal CT scan showed an irregular tumour, sized 12 cm in diameter, involving the pancreatic tail and the stomach (Fig. 1) with multiple hepatic tumours. The central part of the tumour showed no enhancement, suggesting massive necrosis, while the circumferential part of the tumour was well enhanced, thereby suggesting viable components. Emergent gastroscopy revealed an irregular ulcer formation on the upper to middles part of the stomach with slight bleeding, which also showed that the tumour was not originated from the gastric mucosa, and biopsy of the mucosa proved adenocarcinoma. A clinical diagnosis of pancreatic cancer or gastric cancer with multiple liver metastases was made. As massive gastric bleeding continued for a week, total gastrectomy with distal pancreatectomy and biopsy of the liver tumour was performed to rescue the patient by a palliative surgery. The postoperative course was uneventful.
In gross findings, the tumour was a grey, solid, lobulated and
well-circumscribed mass with central necrosis. Histopathologically,
this tumour showed a mixed pattern, with acinar pattern, reminiscent
of normal pancreatic acinar tissue, alternating with trabecular
and solid formations (
Fig. 2), which coincided with the liver
metastasis. On immunohistochemical examination, the tumour stained
for trypsin and lipase. A final diagnosis of acinar cell adenocarcinoma
of the pancreas was made. (Please note that a colour version
of
Fig. 2 is available as supplementary data at
http://www.jjco.oxfordjournals.org)
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