Korean J Radiol.  2010 Jun;11(3):378-381. 10.3348/kjr.2010.11.3.378.

Imaging Findings in a Case of Mixed Acinar-Endocrine Carcinoma of the Pancreas

• Chung WJ
• Byun JH
• Lee SS
• Lee MG

• KMID: 946281
• DOI: http://doi.org/10.3348/kjr.2010.11.3.378

Abstract

Mixed acinar-endocrine carcinoma (MAEC) of the pancreas is extremely uncommon. We report here a rare case of MAEC of the pancreas presenting as watery diarrhea. This is the first report in the English-language literature that describes the imaging findings of MAEC of the pancreas, including computed tomography (CT), magnetic resonance (MR) imaging, and MR cholangiopancreatography features.

Keyword

Pancreas; Mixed acinar-endocrine carcinoma; Endocrine; Exocrine

MeSH Terms

Carcinoma, Acinar Cell/*pathology/*radiography/surgery
Cholangiopancreatography, Magnetic Resonance/methods
Diagnosis, Differential
Diarrhea
Endocrine Gland Neoplasms/*pathology/*radiography/surgery
Female
Humans
Magnetic Resonance Imaging/methods
Middle Aged
Pancreas/pathology/radiography/surgery
Pancreatectomy
Pancreatic Neoplasms/*pathology/*radiography/surgery
Splenectomy
Tomography, X-Ray Computed/methods

Figure

• 

  Fig. 1 59-year-old woman presented with watery diarrhea that had persisted for two years. A. On contrast-enhanced axial CT scan during hepatic arterial phase, tail of pancreas, which is approximately half length of longest pancreatic axis, was diffusely replaced by heterogeneously hypo-attenuating mass-like lesion (arrows). Approximately 1.5-cm hypervascular nodule (open arrow) was also visible in mass. B. T2-weighted axial MR image indicates that mass (arrows) was heterogeneously hyperintense compared to normal pancreas, except for heterogeneously hypointense nodule (open arrow) in mass. C. Contrast-enhanced T1-weighted axial MR image during hepatic arterial phase showed that tumor (arrows) enhances heterogeneously with multiple well or poorly enhancing areas relative to normal pancreas. Nodule (open arrow) in mass was also found to be well enhanced. D. MR cholangiopancreatography showed that tumor (arrows) was hyperintense with multiple hypointense nodular lesions. E. Photograph of surgical specimen reveals well-demarcated, lobulate, soft-tissue mass (arrows) located at tail of pancreas. Areas of hemorrhage and focal necrosis with cystic change in mass are evident. S = spleen F. Immunohistochemistry results suggest that tumor cells are immunoactive for anti-trypsin (×200). G. Photomicrograph of mass with immunohistochemical staining showed that tumor cells are immunoactive for synaptophysin (×100).

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