Pancreatic acinar cell carcinoma--literature review and case report of a 56-year-old man presenting with abdominal pain

Abstract

We present a case of acinar cell carcinoma of the pancreas (ACC) with metastasis to the liver in a patient who presented with complaints abdominal pain. The presentation, diagnosis, and management of a 56-year-old man with ACC are discussed here. Imaging with computerized tomography (CT) in particular is crucial in the diagnosis, which can identify the primary lesion as well as metastases. ACC should be considered in the differential as a source of abdominal, epigastric, or back pain with imaging that is suggestive of the diagnosis as prompt recognition and initiation of treatment is paramount in the overall prognosis.

Keywords: Computed tomography; Diagnostic radiology; Magnetic resonance imaging; Oncologic radiology; Pancreatic acinar cell carcinoma.

Fig. 1

Axial contrast enhanced CT of the abdomen demonstrates a well-circumscribed heterogeneously enhancing pancreas tail mass (red arrowhead) compressing the neighboring stomach and splenic flexure of the colon. (Color version of figure is available online.)

Fig. 2

Axial contrast enhanced CT of the abdomen demonstrates a subcapsular hepatic segment II lesion (red arrowhead) highly concerning for a metastasis. (Color version of figure is available online.)

Fig. 3

Axial fat suppressed T2-weighted turbo spin-echo image through the abdomen shows a well-circumscribed homogeneously low signal intensity mass within the tail of the pancreas (red arrowhead). No associated high signal intensity components evident. (Color version of figure is available online.)

Fig. 4

Axial diffusion-weighted image (left) with b value of 800 s/mm² and apparent diffusion coefficient (ADC) map (right). The lesion (red arrowheads) shows restriction diffusion seen as high signal intensity on the diffusion weighted image and low signal intensity on the corresponding ADC map. (Color version of figure is available online.)

Fig. 5

Axial 3D gradient-echo fat-suppressed T1-weighted image without contrast of the shows near homogeneous intermediate signal intensity of the pancreatic tail mass (red arrowhead). (Color version of figure is available online.)

Fig. 6

Axial subtraction portal venous phase contrast-enhanced 3D gradient-echo fat-suppressed T1-weighted image demonstrates diffuse enhancement of the pancreatic tail mass with some central heterogeneity (red arrowhead). (Color version of figure is available online.)

Fig. 7

Axial contrast-enhanced CT of the abdomen after chemotherapy shows interval increase in size of previously detected hepatic segment II metastasis (yellow arrowhead), and a new hepatic segment VIII (red arrowhead) metastasis. (Color version of figure is available online.)