Korean J Gastroenterol.  2010 Feb;55(2):139-143. 10.4166/kjg.2010.55.2.139.

A Case of Acinar Cell Carcinoma of Pancreas, Manifested by Subcutaneous Nodule as Initial Clinical Symptom

• Jang SH
• Choi SY
• Min JH
• Kim TW
• Lee JA
• Byun SJ
• Lee JW

• KMID: 1718298
• DOI: http://doi.org/10.4166/kjg.2010.55.2.139

Abstract

Pancreas acinar cell carcinoma (ACC) accounts for only 1-2% of pancreatic exocrine malignant tumor. The symptoms of patients with ACC are usually non-specific, for example the anorexia and weight loss. Patients may develop Schmid's triad including subcutaneous fat necrosis, polyarthritis, and eosinophilia. We reported a case of ACC which was manifested by subcutaneous nodule as initial clinical symptom. To our knowledge, this is the first reported case of ACC presenting as subcutaneous fat necrosis in Korea.

Keyword

Pancreas; Carcinoma; Acinar cell; Suncutaneous fat; Necrosis

MeSH Terms

Carcinoma, Acinar Cell/*diagnosis/surgery/ultrasonography
Fat Necrosis/pathology
Humans
Keratins/metabolism
Male
Middle Aged
Pancreatic Neoplasms/*diagnosis/surgery/ultrasonography
Subcutaneous Fat/*pathology
Synaptophysin/metabolism
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Subcutaneous nodule finding. (A) 1-2 cm sized erythematous to brown colored tender subcutaneous nodule was seen on the left leg. (B) It showed fat necrosis with chronic active inflammation and granulomatous reaction (H&E, ×100).

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  Fig. 2. Abdominal computed tomography finding. It showed diffuse enlargement and heteroge-nicity of pancreas with multiple low density lesions in parenchy-me.

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  Fig. 3. Endoscopic ultrasonography finding. It showed diffuse parenchymal enlargement of pancreas. Multiple strictures and di-latations of main pancreatic duct were noted. About 6.4×6.6 cm sized isoechogenic mass like lesion was noted in body of pancreas.

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  Fig. 4. Tumor was lobulated and had yellowish cut surface with hemorrhage and necrosis. Tumor mass measured 13×9×4 cm.

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  Fig. 5. Microscopic finding. (A) Infiltrating solid nests of tumor cells with surrounding fibrosis were observed within the pancreatic tissue (H&E, ×100). (B) Acinar pattern with pleomorphic oval nucleoli and eosinophilic cytoplasm were observed (H&E, ×400). (C) The tumor cells were weak positive for synaptophysin (×100) and (D) positive for cytokeratin (×200).

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