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Case Reports
. 2021 Sep 1;60(17):2799-2806.
doi: 10.2169/internalmedicine.7121-21. Epub 2021 Mar 22.

Acinar Cell Carcinoma with Morphological Change in One Month

Mio Ikeda  1 , Shin Miura  1 , Shin Hamada  1 , Takanori Sano  1 , Ryotaro Matsumoto  1 , Yu Tanaka  1 , Seiji Hongo  1 , Naoki Yoshida  1 , Tetsuya Takikawa  1 , Kazuhiro Kikuta  1 , Kiyoshi Kume  1 , Tatsuo Hata  2 , Michiaki Unno  2 , Yuko Omori  3 , Toru Furukawa  3 , Atsushi Masamune  1
Affiliations
Case Reports

Acinar Cell Carcinoma with Morphological Change in One Month

Mio Ikeda et al. Intern Med. .

Abstract

A 64-year-old man was admitted to our hospital to undergo examination of a pancreatic tumor accompanied by sudden epigastric pain. The tumor had a well-defined oval shape that was mostly less enhanced, with the exception of part of the tumor on the pancreatic head side, on contrast enhanced (CE)-CT. However, CE-CT performed one-month later revealed that the viable part of the tumor grew toward the pancreatic tail with the reduction of necrotic tissue. We performed distal pancreatectomy and the tumor was diagnosed as acinar cell carcinoma (ACC). One important characteristic of ACC is that it may develop morphological changes within a short period of time.

Keywords: ERCP; EUS; pancreatic cancer; pancreatic tumor.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Contrast-enhanced computed tomography. White arrows show the pancreatic tumor. (a) Plain, (b) Early phase, (c) Portal phase, (d) Late phase.
Figure 2.
Figure 2.
The magnetic resonance imaging. White arrows show the pancreatic tumor. (a) T1WI, (b) T2WI, (c) Diffusion-WI, (d) MRCP.
Figure 3.
Figure 3.
Endoscopic retrograde cholangiopancreatography. White arrow shows the filling defect in the main pancreatic duct.
Figure 4.
Figure 4.
Endoscopic ultrasound. White arrows show the pancreatic tumor. White arrowheads show the viable portion of the tumor. (a) B-mode, (b) Contrast enhanced harmonic image.
Figure 5.
Figure 5.
Positron emission tomography-computed tomography. (a) An image of the whole body, (b) The white arrow shows the pancreatic tumor, (c) The white arrow shows the accumulation of FDG in the duodenum.
Figure 6.
Figure 6.
Computed tomography changes after one month. The area without a contrast effect was reduced (arrows), while the viable portion grew from the pancreatic head side toward the tail side (arrowheads) in one month. (a) The initial image, (b) The image obtained one month later.
Figure 7.
Figure 7.
Endoscopic ultrasound changes after one month. EUS showed that the viable portion protruded from the pancreatic head side to the tail side (arrowheads), and the low-echo area decreased (arrows). (a) The initial image, (b) The image obtained one month later.
Figure 8.
Figure 8.
The histopathological findings. The tumor, which measured 75 mm, was located in the pancreatic tail to the body of the pancreas. On the pancreatic head side, a tumor thrombus extended into the main pancreatic duct (dotted line: main pancreatic duct, broken line: tumor). The mass had extensive necrosis (arrowheads). The tumor had spread into the branch duct and invaded the pancreatic parenchyma (solid line).
Figure 9.
Figure 9.
Histopathological findings. (a) Hematoxylin and Eosin (H&E) staining, ×40, (b) H&E staining, ×400, (c) BCL-10, (d) Trypsin, (e) α1-antitrypsin, (f) α1-antichymotrypsin.
Figure 10.
Figure 10.
Two cases in which image changes were confirmed during the disease course. (a) Case No. 4 in Table, (a-1) The initial image, (a-2) An image obtained one month later, (b) Case No. 6 in Table, (b-1) The initial image, (b-2) An image obtained one month later.
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