Korean J Hepatobiliary Pancreat Surg.  2014 Feb;18(1):33-37. 10.14701/kjhbps.2014.18.1.33.

AFP-producing acinar cell carcinoma treated by pancreaticoduodenectomy in a patient with a previous radical subtotal gastrectomy by gastric cancer

Affiliations
  • 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. cmkang@yuhs.ac
  • 2Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
  • 3Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Severance Hospital, Seoul, Korea.

Abstract

We report a case of alpha-fetoprotein (AFP)-producing acinar cell carcinoma (ACC) of the pancreas. The tumor was diagnosed in a 72 yearold female after radical subtotal gastrectomy (Billroth I) due to early gastric cancer six months before. The initial serum AFP levels were increased to 2,254.1 IU/ml and preoperative imaging studies showed a mass with approximately 2.5 cm in diameter near the neck of the pancreas. A pancreaticoduodenectomy was performed. The pathologic examination revealed an ill-defined lobulating tumor confined to the pancreas (T1 stage). Immunohistochemical study showed that the tumor cells expressed AFP. The Adenosine triphosphate-based chemotherapy response assay (ATP-CRA) suggested that cisplatin would be more desirable than gemcitabine in AFP-producing ACC of the pancreas as an adjuvant chemotherapy. However, the adjuvant chemotherapy was not performed due to the early pathological stage. The patient died from carcinomatosis and pneumonia. Even if the tumor was on a relatively early stage, an adjuvant treatment should be considered ACC.

Keyword

Alpha-fetoprotein; Acinar cell carcinoma; Pancreatectomy; Gastric cancer

MeSH Terms

Acinar Cells*
Adenosine
alpha-Fetoproteins
Carcinoma
Carcinoma, Acinar Cell*
Chemotherapy, Adjuvant
Cisplatin
Drug Therapy
Female
Gastrectomy*
Humans
Neck
Pancreas
Pancreatectomy
Pancreaticoduodenectomy*
Pneumonia
Stomach Neoplasms*
Adenosine
Cisplatin
alpha-Fetoproteins

Figure

  • Fig. 1 Preoperative image study findings. CT scan showed about a 2.5 cm-sized mass near the pancreatic neck portion without evidences of distant metastasis (A). No definitive hypermetabolic signal intensity was shown in FDG-PET scan (B). Filling defect and dilatation of the distal pancreatic duct was shown on magnetic resonance cholangiopancreatography (C).

  • Fig. 2 Intraoperative findings. Severe adhesions were noted, especially around the common hepatic artery and the celiac axis. The pancreatic neck portion needed first to be dissected for the anatomic landmark identification. The round mass at the posterior aspect of the pancreatic neck portion (long, thick arrow) should be noted (A), an operative finding after pancreatoduodenectomy. The stump of the gastroduodenal artery is noted (short, thin arrow) (B). SMV, superior mesenteric vein; SV, splenic vein; PV, portal vein; S, remnant stomach; P, remnant pancreas; BD, common hepatic duct.

  • Fig. 3 Surgical pathology and postoperative course. An about 1.9 cm-sized pancreas-confining lobulated tumor was noted on the neck of the pancreas (A). The tumor cells are arranged in irregular solid sheets and acinar pattern (B, ×100), The AFP immunohistochemical staining was diffuse positive in tumor cells (C, ×100). The patient got no adjuvant chemotherapy in follow up. The serial follow up of serum AFP showed re-elevation after declining near the normal level following operation (D). H&E, hematoxylin-eosin.


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