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Liu BJ, Jin CH, Guo YL, Ke ZG, Huang JJ, Cao LP. Pancreatic giant malignancy simulating a gastrointestinal stromal tumor. Hepatobiliary Pancreat Dis Int 2024; 23:431-433. [PMID: 37516590 DOI: 10.1016/j.hbpd.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Ben-Jie Liu
- Department of Hepatobiliary Surgery, Department of General Surgery, Pujiang Branch of the First Affiliated Hospital, Zhejiang University School of Medicine, Jinhua 322200, China
| | - Chen-Hui Jin
- Department of Pathology, Pujiang Branch of the First Affiliated Hospital, Zhejiang University School of Medicine, Jinhua 322200, China
| | - Yan-Lun Guo
- Department of Hepatobiliary Surgery, Department of General Surgery, Pujiang Branch of the First Affiliated Hospital, Zhejiang University School of Medicine, Jinhua 322200, China
| | - Zhi-Gang Ke
- Department of Hepatobiliary Surgery, Department of General Surgery, Pujiang Branch of the First Affiliated Hospital, Zhejiang University School of Medicine, Jinhua 322200, China
| | - Jun-Jun Huang
- Department of Hepatobiliary Surgery, Department of General Surgery, Pujiang Branch of the First Affiliated Hospital, Zhejiang University School of Medicine, Jinhua 322200, China
| | - Lin-Ping Cao
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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2
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Ciardiello D, Urbano F, Zamboni G, Palladino N, Bazzocchi F, Parente P. Left abdominal mass with carcinosis: Unusual presentation of pancreatic acinar cell carcinoma. Hepatobiliary Pancreat Dis Int 2023; 22:412-414. [PMID: 36307307 DOI: 10.1016/j.hbpd.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Davide Ciardiello
- Oncology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
| | - Filomena Urbano
- Radiology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
| | - Giuseppe Zamboni
- Pathology Unit, Ospedale Sacro Cuore Don Calabria, vai Sempreboni, Negrar and University of Verona, Negrar 37024, VR, Italy
| | - Nicola Palladino
- Radiology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
| | - Francesca Bazzocchi
- Abdominal Surgical Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy.
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3
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Uruga H, Tamura T, Miura Y, Itonaga J, Koyama R, Imamura T, Takazawa Y. Pancreatic acinar cell carcinoma with pleomorphic and spindle cells: An autopsy-proven case. Pathol Int 2023. [PMID: 37133201 DOI: 10.1111/pin.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
Abstract
Pancreatic acinar cell carcinomas are glandular and have amphophilic/eosinophilic cytoplasm, presenting acinar, solid, and trabecular structures. Unusual histological features of acinar cell carcinoma are known, such as oncocytic, pleomorphic, spindle, and clear cell variants, but their clinical significance has not been well described. A man in his 70s was referred to our hospital because of elevated serum pancreatic enzymes. Contrast-enhanced abdominal computed tomography revealed slight swelling of the pancreatic head and suspension of the main pancreatic duct in the pancreatic body. He died only 14 days after admission. Gross findings at autopsy showed an ill-defined tumor located in the pancreatic head, involving the gastric and duodenal walls. Peritoneal dissemination, liver metastases, and lymph node metastases were also observed. Microscopically, tumor cells had moderate-to-severe nuclear atypia and amphophilic cytoplasm showing pleomorphism, and diffusely proliferated in solid pattern without lumina, were admixed with spindle cells. Immunohistochemically, tumor cells including pleomorphic and spindle cells were positive for B-cell lymphoma/leukemia 10 and trypsin. Consequently, the diagnosis was pancreatic acinar cell carcinoma with pleomorphic and spindle cells. We encountered a rare variant of pancreatic acinar cell carcinoma with pleomorphic and spindle cells. Clinically, our case showed rapid progression.
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Affiliation(s)
- Hironori Uruga
- Department of Diagnostic Pathology, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Tetsuo Tamura
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yasuro Miura
- Department of Diagnostic Pathology, Toranomon Hospital, Tokyo, Japan
| | - Jumpei Itonaga
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Rikako Koyama
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Tsunao Imamura
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yutaka Takazawa
- Department of Diagnostic Pathology, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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4
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Tran K, Prall OW, Mitchell C, Chou A, Gill AJ, Grimmond SM, Kong G, Kiernan G, Torche C, Lipton L, Thomson B, Ko HS. Diagnosing Primary Pancreatic Acinar Cell Carcinoma – Clinical Correlation of Radiological/Molecular Imaging, Histopathologic features and Whole Genome/Transcriptome Profiling, and Review of the Literature. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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5
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He M, Wang X, Xu J, Li J, Chang X, Zins M, Jin Z, Xue H. Diffuse Involvement of Pancreas is not Always Autoimmune Pancreatitis. Acad Radiol 2022; 29:1523-1531. [PMID: 35279380 DOI: 10.1016/j.acra.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/09/2022] [Accepted: 01/16/2022] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the prevalence of diffuse involvement of pancreas and to identify the findings of malignancies using enhancement computed tomography (CT). MATERIALS AND METHODS A total of 1,0249 patients performed enhancement CT in our hospital over 62 months were investigated and the final study cohort includes 245 patients (170 males, 75 females; mean age, 56.94 ± 12.17 years). The reference standard is the final clinical/pathological diagnosis. The lesion-to-aorta enhancement ratio (LAR) on the pancreatic arterial phase, portal phase and delayed phase (DP) and the traditional CT findings were evaluated. Intergroup comparisons between malignancies and non-malignancies lesions were performed. Univariate and multivariate analyses were conducted to identify findings predicting malignancies. RESULTS The prevalence of malignancy was 45.3% (111/245) of diffuse enlargement of pancreas. All benign lesions were autoimmune pancreatitis 54.7% (n = 134). The most common malignant lesion was pancreatic ductal adenocarcinoma (n = 88, 35.9%). Other rare lesions with malignant potential included pancreatic neuroendocrine tumor (n = 11, 4.5%), lymphoma (n = 4, 1.6%), metastasis (n = 4, 1.6%), solid pseudopapillary neoplasm (n = 3, 1.2%) and acinar cell carcinoma (n = 1, 0.4%). Residual normal pancreas parenchyma, heterogeneity, short axis (cut-off value, 3.15 cm) and LARDP (cut-off value, 0.75) were independent predictors of malignancies. When the above predictors were combined, a sensitivity of 94.2%, a specificity of 90.8% were attained. CONCLUSION Diffuse involvement of the pancreas is rare and is not a specific sign of autoimmune pancreatitis, and it is associated with a wide spectrum of malignant conditions. Dynamic enhancement CT is helpful to identifying malignancies.
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Affiliation(s)
- Ming He
- Department of Radiology, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China; Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Xiheng Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Jin Xu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Juan Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Marc Zins
- Department of Rathology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing 100703, China.
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6
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Uhlig R, Contreras H, Weidemann S, Gorbokon N, Menz A, Büscheck F, Luebke AM, Kluth M, Hube-Magg C, Hinsch A, Höflmayer D, Fraune C, Möller K, Bernreuther C, Lebok P, Sauter G, Wilczak W, Izbicki J, Perez D, Schrader J, Steurer S, Burandt E, Krech R, Dum D, Krech T, Marx A, Simon R, Minner S, Jacobsen F, Clauditz TS. Carboxypeptidase A1 (CPA1) Immunohistochemistry Is Highly Sensitive and Specific for Acinar Cell Carcinoma (ACC) of the Pancreas. Am J Surg Pathol 2022; 46:97-104. [PMID: 34889867 PMCID: PMC8860221 DOI: 10.1097/pas.0000000000001817] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Carboxypeptidase A1 (CPA1) is a zinc metalloprotease that is produced in pancreatic acinar cells and plays a role in cleaving C-terminal branched-chain and aromatic amino acids from dietary proteins. This study assessed the utility of immunohistochemical CPA1 staining for diagnosing pancreatic acinar cell carcinoma (ACC). A total of 12,274 tumor samples from 132 different tumor types and subtypes as well as 8 samples each of 76 different normal tissue types were interpretable by immunohistochemistry in a tissue microarray format. CPA1 was strongly expressed in acinar cells of all normal pancreas samples but not in any other normal tissues. CPA1 immunostaining was detected in 100% of 11 pancreatic ACCs and 1 mixed acinar endocrine carcinoma, but absent in 449 pancreatic ductal adenocarcinomas, 75 adenocarcinomas of the ampulla Vateri, and 11,739 other evaluable cancers from 128 different tumor entities. A weak to moderate diffuse staining of epithelial and stromal cells of cancer tissues immediately adjacent to non-neoplastic pancreatic acinar cells often occurred and was considered to be caused by the diffusion of the highly abundant CPA1 from normal acinar cells that may have suffered some autolytic cell damage. In conclusion, our data show that CPA1 is a highly sensitive and largely specific marker for normal and neoplastic pancreatic acinar cells. CPA1 immunohistochemistry greatly facilitates the otherwise often difficult diagnosis of pancreatic ACC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jakob Izbicki
- General, Visceral and Thoracic Surgery Department and Clinic
| | - Daniel Perez
- General, Visceral and Thoracic Surgery Department and Clinic
| | - Jörg Schrader
- General, Visceral and Thoracic Surgery Department and Clinic
- I. Medical Department—Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg
| | | | | | - Rainer Krech
- Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck
| | | | - Till Krech
- Institute of Pathology
- Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck
| | - Andreas Marx
- Institute of Pathology
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
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7
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Qin L, Shen J, Yang Y, Zou Z. Rapid Response to the Combination of Lenvatinib and Sintilimab in a Pancreatic Acinar Cell Carcinoma Patient With Elevated Alpha-Fetoprotein: A Case Report. Front Oncol 2021; 11:692480. [PMID: 34745936 PMCID: PMC8564141 DOI: 10.3389/fonc.2021.692480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022] Open
Abstract
A 48-year old woman was diagnosed with metastatic pancreatic acinar cell carcinoma (PACC) and with a marked elevation in alpha-fetoprotein (AFP), this being a recognized but uncommon feature of PACC. As she refused chemotherapy, the combined therapy of lenvatinib and sintilimab (lenvatinib 8 mg, orally, qd; and sintilimab 100 mg, intravenous glucose tolerance test, q21d) was given, which conferred significant tumor shrinkage and long progression-free survival (>21 months). This study is the first report and description of a PACC demonstrating favorable response to the combination therapy of an antiangiogenic agent and immunotherapy.
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Affiliation(s)
- Lanqun Qin
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Jie Shen
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, China.,The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yueling Yang
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhengyun Zou
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, China.,The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
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8
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Sui H, Zhu Z, Li Z, Luo Y. Primary Pancreatic Yolk Sac Tumor Presenting as Diffusely Enlarged Pancreas in Initial 18F-FDG PET/CT. Clin Nucl Med 2020; 45:483-486. [PMID: 32332317 DOI: 10.1097/rlu.0000000000003038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Yolk sac tumor is a rare and highly malignant germ cell tumor. We report a case of yolk sac tumor primarily in the pancreas in a 32-year-old man. He presented with pancreatitis at presentation with significantly increased serum alpha-fetoprotein (AFP). F-FDG PET/CT revealed diffuse enlargement of the pancreas in the neck, body, and tail portion with homogeneously increased FDG uptake, similar to the change of pancreatitis. The lesion progressively developed to a huge pancreatic mass in the follow-up images, and endoscopic ultrasonography-guided aspiration biopsy of the pancreatic mass confirmed the diagnosis of yolk sac tumor.
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Affiliation(s)
- Huimin Sui
- From the Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC; and Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, People's Republic of China
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9
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Moradi F, Iagaru A. The Role of Positron Emission Tomography in Pancreatic Cancer and Gallbladder Cancer. Semin Nucl Med 2020; 50:434-446. [PMID: 32768007 DOI: 10.1053/j.semnuclmed.2020.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
18F-FDG-PET is complementary to conventional imaging in patients with clinical suspicion for exocrine pancreatic malignancies. It has similar if not superior sensitivity and specificity for detection of cancer, and when combined with contrast enhanced anatomic imaging of the abdomen, can improve diagnostic accuracy and aid in staging, assessment for resectability, radiation therapy planning, and prognostication. Various metabolic pathways affect FDG uptake in pancreatic ductal adenocarcinoma. The degree of uptake reflects histopathology, aggressiveness, metastatic potential, and metabolic profile of malignant cell and their interaction with cancer stroma. After treatment, FDG-PET is useful for detection of residual or recurrent cancer and can be used to assess and monitor response to therapy in unresectable or metastatic disease. The degree and pattern of uptake combined with other imaging features are useful in characterization of incidental pancreatic lesions and benign processes such as inflammation. Several novel PET radiopharmaceuticals have been developed to improve detection and management of pancreatic cancer. Gallbladder carcinoma is typically FDG avid and when anatomic imaging is equivocal PET can be used to assess metastatic involvement with high specificity and inform subsequent management.
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Affiliation(s)
- Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford University, Stanford, CA.
| | - Andrei Iagaru
- Division of Nuclear Medicine, Department of Radiology, Stanford University, Stanford, CA
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10
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Barat M, Dohan A, Gaujoux S, Hoeffel C, Jornet D, Oudjit A, Coriat R, Barret M, Terris B, Soyer P. Computed tomography features of acinar cell carcinoma of the pancreas. Diagn Interv Imaging 2020; 101:565-575. [PMID: 32146131 DOI: 10.1016/j.diii.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To report the computed tomography (CT) features of pancreatic acinar cell carcinoma (ACC) and identify CT features that may help discriminate between pancreatic ACC and pancreatic ductal adenocarcinoma (PDA). MATERIALS AND METHODS The CT examinations of 20 patients (13 men, 7 women; mean age, 66.5±10.7 [SD] years; range: 51-88 years) with 20 histopathologically proven pancreatic ACC were reviewed. CT images were analyzed qualitatively and quantitatively and compared to those obtained in 20 patients with PDA. Comparisons were performed using univariate analysis with a conditional logistic regression model. RESULTS Pancreatic ACC presented as an enhancing (20/20; 100%), oval (15/20; 75%), well-delineated (14/20; 70%) and purely solid (13/20; 65%) pancreatic mass with a mean diameter of 52.6±28.0 (SD) mm (range: 24-120mm) in association with visible lymph nodes (14/20; 70%). At univariate analysis, well-defined margins (Odds ratio [OR], 7.00; P=0.005), nondilated bile ducts (OR, 9.00; P=0.007), visible lymph nodes (OR, 4.33; P=0.028) and adjacent organ involvement (OR, 5.67; P=0.02) were the most discriminating CT features to differentiate pancreatic ACC from PDA. When present, lymph nodes were larger in patients with pancreatic ACC (14±4.8 [SD]; range: 7-25mm) than in those with PDA (8.8±4.1 [SD]; range: 5-15mm) (P=0.039). CONCLUSION On CT, pancreatic ACC presents as an enhancing, predominantly oval and purely solid pancreatic mass that most frequently present with no bile duct dilatation, no visible lymph nodes, no adjacent organ involvement and larger visible lymph nodes compared to PDA.
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Affiliation(s)
- M Barat
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France.
| | - A Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - S Gaujoux
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Abdominal Surgery, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - C Hoeffel
- Department of Radiology, Hôpital Robert Debré, 51092 Reims, France
| | - D Jornet
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - A Oudjit
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - R Coriat
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - M Barret
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - B Terris
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - P Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
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11
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Miyoshi H, Kano M, Kobayashi S, Ito T, Masuda M, Mitsuyama T, Nakayama S, Ikeura T, Shimatani M, Uchida K, Takaoka M, Okazaki K. Diffuse Pancreatic Cancer Mimicking Autoimmune Pancreatitis. Intern Med 2019; 58:2523-2527. [PMID: 31178502 PMCID: PMC6761344 DOI: 10.2169/internalmedicine.2689-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The characteristic finding of sausage-shaped pancreas or capsule-like rim facilitates the diagnosis of autoimmune pancreatitis. We herein report a case of a 67-year-old man showing a sausage-shaped, enlarged pancreas with a capsule-like rim on computed tomography. Furthermore, endoscopic retrograde cholangiopancreatography demonstrated diffuse narrowing of the main pancreatic duct, in addition to stenosis of the lower bile duct. Finally, we were able to diagnose pancreatic cancer in this patient by an endoscopic ultrasound-guided fine-needle aspiration biopsy following peroral cholangioscopy and bile cytology. This report emphasizes the significance of pathological confirmation before starting treatment, even in cases with diffuse pancreatic enlargement.
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Affiliation(s)
- Hideaki Miyoshi
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Masataka Kano
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Sanshiro Kobayashi
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Takashi Ito
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Masataka Masuda
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Toshiyuki Mitsuyama
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Shinji Nakayama
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Tsukasa Ikeura
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Masaaki Shimatani
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Kazushige Uchida
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Makoto Takaoka
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
| | - Kazuichi Okazaki
- Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
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12
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Jornet D, Soyer P, Terris B, Hoeffel C, Oudjit A, Legmann P, Gaujoux S, Barret M, Dohan A. MR imaging features of pancreatic acinar cell carcinoma. Diagn Interv Imaging 2019; 100:427-435. [PMID: 30846400 DOI: 10.1016/j.diii.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to report the magnetic resonance imaging (MRI) features of acinar cell carcinoma (ACC) of the pancreas including diffusion-weighted MRI findings. MATERIALS AND METHODS The MRI examinations of five patients (3 men, 2 women; median age, 61years) with histopathologically proven ACC of the pancreas were retrospectively reviewed. MR images were analyzed qualitatively (location, shape, homogeneity, signal intensity, vascular involvement and extrapancreatic extent of ACC) and quantitatively (tumor size, apparent diffusion coefficient [ADC] and normalized ADC of ACC). RESULTS All ACC were visible on MRI, presenting as an oval pancreatic mass (5/5; 100%), with moderate and heterogeneous enhancement (5/5; 100%), with a median transverse diameter of 43mm (Q1, 35; Q3, 82mm; range: 30-91mm). Tumor capsule was visible in 4/5 ACC (80%) and Wirsung duct enlargement in 2/5 ACC (40%). On diffusion-weighted MRI, all ACC (5/5; 100%) were hyperintense on the 3 b value images. Median ADC value of ACC was 1.061×10-3mm2/s (Q1, 0.870×10-3mm2/s; Q3, 1.138×10-3mm2/s; range: 0.834-1.195×10-3mm2/s). Median normalized ADC ratio of ACC was 1.127 (Q1, 1.071; Q3, 1.237; range: 1.054-1.244). CONCLUSIONS On MRI, ACC of the pancreas presents as a large, oval pancreatic mass with moderate and heterogeneous enhancement after intravenous administration of a gadolinium chelate, with restricted diffusion and a median ADC value of 1.061×10-3mm2/s on diffusion-weighted MRI. Further studies however are needed to confirm our findings obtained in a limited number of patients.
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Affiliation(s)
- D Jornet
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Soyer
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; UMR Inserm 965, 2, rue Amboise-Paré, 75010 Paris, France
| | - B Terris
- Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Hoeffel
- Department of Radiology, Hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France
| | - A Oudjit
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Legmann
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France
| | - S Gaujoux
- Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; Department of Abdominal surgery, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Barret
- Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Dohan
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; UMR Inserm 965, 2, rue Amboise-Paré, 75010 Paris, France.
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