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Updated: Jan 18, 2026
Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique
Published on: February 2, 2022
[A Case of Acinar Cell Carcinoma-Difficult to Differentiate on Imaging Pre-Laparoscopic Distal Pancreatectomy]
Mao Nakade1, Shinsuke Nakashima, Hirotoshi Takayama
1Dept. of Gastroenterological Surgery, Higashiosaka City Medical Center.
Abstract:
An 80s man was diagnosed appendicitis and an incidental 33 mm cystic mass with a substantial component in the pancreatic body by contrast-enhanced CT. The enhancement component was stained early contrast. By MRI, component was pale high signal on diffusion-weighted images, and low signal ADC maps. The cyst was low signal on T1WI and slightly heterogeneous high signal on T2WI. Because of suspected mucinous cystic neoplasm(MCN), we performed laparoscopic distal pancreatectomy. By immunostaining, BCL-10 and trypsin were positive. Definite diagnosis was acinar cell carcinoma(ACC). He has been recurrence-free for 5 years without additional treatment. When a pancreatic mass with a mixture of cystic and enhancing components is found, ACC should be included int the differential diagnosis.
Insights
A rare case of acinar cell carcinoma (ACC) presented as a cystic pancreatic mass. Surgical resection led to a 5-year recurrence-free survival, highlighting ACC in pancreatic mass differential diagnosis.
Area of Science:
- Oncology
- Gastroenterology
- Radiology
Background:
- Pancreatic cystic neoplasms present a diagnostic challenge.
- Acinar cell carcinoma (ACC) is a rare pancreatic malignancy.
- Distinguishing ACC from other cystic lesions is crucial for appropriate management.
Purpose of the Study:
- To report a case of acinar cell carcinoma (ACC) initially suspected as a mucinous cystic neoplasm (MCN).
- To illustrate the imaging characteristics of ACC on CT and MRI.
- To emphasize the importance of considering ACC in the differential diagnosis of mixed cystic and enhancing pancreatic masses.
Main Methods:
- Contrast-enhanced CT and MRI were utilized for initial characterization of the pancreatic mass.
- Laparoscopic distal pancreatectomy was performed for suspected MCN.
- Immunohistochemical staining (BCL-10 and trypsin) was used for definitive diagnosis.
Main Results:
- A 33 mm pancreatic cystic mass with an enhancing component was identified.
- Imaging revealed specific signal characteristics on diffusion-weighted images and ADC maps.
- Immunostaining confirmed the diagnosis of acinar cell carcinoma (ACC).
- The patient remained recurrence-free for 5 years post-surgery without further treatment.
Conclusions:
- Acinar cell carcinoma (ACC) can present as a cystic pancreatic mass with enhancing components.
- Multimodality imaging is essential for characterizing pancreatic lesions.
- ACC should be included in the differential diagnosis for mixed cystic and enhancing pancreatic masses.
