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. 2017 Dec;3(1):51.
doi: 10.1186/s40792-017-0326-y. Epub 2017 Mar 30.

Metastatic mixed acinar-endocrine carcinoma of the pancreas treated with a multidisciplinary approach: a case report

Takeo Hara  1 , Yoshiyuki Fujiwara  2 , Hidenori Takahashi  1 , Keijiro Sugimura  1 , Jeong-Ho Moon  1 , Takeshi Omori  1 , Norikatsu Miyoshi  1 , Akira Tomokuni  1 , Hirofumi Akita  1 , Shogo Kobayashi  1 , Masayoshi Yasui  1 , Hiroshi Miyata  1 , Masayuki Ohue  1 , Masato Sakon  1 , Yasuhiko Tomita  3 , Masahiko Yano  1
Affiliations

Metastatic mixed acinar-endocrine carcinoma of the pancreas treated with a multidisciplinary approach: a case report

Takeo Hara et al. Surg Case Rep. 2017 Dec.

Abstract

Background: Pancreatic neoplasms are usually characterized by ductal, acinar, or endocrine differentiation. Mixed exocrine and endocrine pancreatic tumours are extremely rare. Here, we report a case of pancreatic mixed acinar-endocrine carcinoma (MAEC) with multiple synchronous liver metastases that were treated with surgery and transcatheter arterial chemoembolization (TACE) that later recurred in the stomach.

Case presentation: A 45-year-old female with severe anaemia was referred to our hospital. Computed tomography (CT) demonstrated a hypervascular tumour, 17 cm in diameter, that was in the tail of the pancreas. In addition, there were multiple hypervascular tumours in the liver. She underwent a distal pancreatectomy with splenectomy after the liver metastases were treated with TACE. Pathology confirmed that the pancreatic tumour was MAEC. After 4.5 years, a follow-up CT showed a hypervascular tumour at the upper part of the stomach. Gastric endoscopy showed a big tumefactive lesion with surface irregularities, gastric erosion, and multiple dilated vessels in the fornix and greater curvature of the stomach. She underwent a proximal gastrectomy and survived 7 years and 2 months after the start of the treatment.

Conclusions: This is the first report of a metastatic stomach tumour from pancreatic MAEC, which was successfully treated with a multidisciplinary approach. Additionally, we review the literature and discuss the treatment of MAEC.

Keywords: Metastatic gastric tumour; Mixed acinar-endocrine carcinoma; Pancreatic neoplasm.

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Figures

Fig. 1
Fig. 1
Abdominal contrast-enhanced CT findings and upper endoscopy findings. CT showing a hypervascular tumour in the tail of the pancreas, infiltrating the spleen and the splenic vein (a). Multiple hypervascular tumours in the liver (b). Hypervascular tumour in the upper part of the stomach (c). Upper endoscopy showing a big tumefactive lesion in the fornix and greater curvature (d)
Fig. 2
Fig. 2
Photograph of Surgical specimen. Pancreas tumour measuring 11 cm, which was white in colour and well demarcated, had expansive lobular growth, and was located in the tail of the pancreas, infiltrating the spleen and the splenic vein (a, b). Gastric tumour measured 9 cm. Tumour was white in colour with a distinct border and had expansive growth under the submucosa (c, d)
Fig. 3
Fig. 3
Histopathological features of the mixed acinar-endocrine carcinoma. Haematoxylin and eosin image of the pancreas tumour, 100× (a). Immunostaining of the pancreas tumour for trypsin 100× (b) and chromogranin A 100× (c). Haematoxylin and eosin image of the gastric tumour, 50× (d). Immunostaining of the gastric tumour for trypsin 50× (e) and chromogranin A 50× (f)
See this image and copyright information in PMC

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