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Acinar cell carcinoma with hypervascularity.

J D Chen1, M S Wu, Y W Tien

  • 1Department of Internal Medicine, National Taiwan University Hospital, Taipei.

Journal of Gastroenterology and Hepatology
|February 24, 2001
PubMed
Summary
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A rare pancreatic acinar cell carcinoma presented atypically in a 60-year-old man. Diagnosis was confirmed via immunohistochemistry and electron microscopy, despite initial mixed clinical indicators.

Area of Science:

  • Gastroenterology and Oncology
  • Surgical Pathology
  • Diagnostic Imaging

Background:

  • Pancreatic acinar cell carcinoma (ACC) is a rare exocrine pancreatic tumor, accounting for approximately 1% of pancreatic malignancies.
  • ACC often presents with vague symptoms, making early diagnosis challenging.
  • This case highlights the diagnostic complexities of ACC, particularly when it mimics other pancreatic neoplasms.

Observation:

  • A 60-year-old Taiwanese male presented with obstructive jaundice, abdominal pain, and significant weight loss.
  • Imaging revealed a hypervascular tumor in the pancreatic head with an irregular stricture involving the common bile and pancreatic ducts.
  • Initial laboratory findings showed normal tumor markers (CEA, CA19-9, AFP) but elevated insulin and C-peptide levels.

Findings:

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  • Despite a mixed clinical presentation suggestive of other pancreatic tumors, immunohistochemical stains and electron microscopic examination confirmed the diagnosis of acinar cell carcinoma.
  • The tumor's hypervascular nature and specific location in the pancreatic head were key imaging findings.
  • Elevated insulin and C-peptide, while unusual for typical exocrine tumors, provided biochemical clues.

Implications:

  • This case underscores the importance of comprehensive diagnostic evaluation, including advanced histopathology, for rare pancreatic tumors.
  • Recognizing the diverse clinical and imaging presentations of acinar cell carcinoma is crucial for timely diagnosis and treatment.
  • Further research into the specific biochemical markers and imaging characteristics of ACC could improve diagnostic accuracy.