[A Case of Pancreatic Acinar Cell Carcinoma Undergoing Two Hepatic Resections for Metachronous Liver Metastases]

The patient was a woman in her 60s who was referred to our hospital for further evaluation and treatment of a pancreatic body mass. Endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)suggested a diagnosis of solid pseudopapillary neoplasm, and she subsequently underwent a spleen-preserving distal pancreatectomy. Twenty-seven months after the initial surgery, a solitary hepatic lesion was detected in S3 of the liver, which was considered a metastatic recurrence. Laparoscopic partial hepatectomy of S3 was performed. Histopathological examination of the resected hepatic tumor was consistent with pancreatic acinar cell carcinoma(ACC), prompting a re-evaluation of the primary pancreatic lesion, which also led to a revised diagnosis of ACC. Thirty-six months after the initial pancreatectomy, another solitary hepatic lesion appeared in S2/3, and was diagnosed as a second hepatic recurrence of ACC. Although chemotherapy was initiated, the response was classified as progressive disease. However, as the lesion remained localized to S2/3 and no new lesions were observed, surgical resection was considered appropriate. A laparoscopic left lateral segmentectomy of the liver was performed. Histopathological examination confirmed that the lesion was a hepatic metastasis of ACC. The patient has since been followed up without adjuvant therapy, and remains recurrence-free 22 months after the second hepatectomy.