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Imaging findings in a case of mixed acinar-endocrine carcinoma of the pancreas.

Chung WJ, Byun JH, Lee SS, Lee MG - Korean J Radiol (2010)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

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.

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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 = spleenF. 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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Figure 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 = spleenF. 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).

Mentions: On the CT scans, the tail of the pancreas, covering approximately half of the longest pancreatic axis, was replaced by a heterogeneously hypoattenuating mass-like lesion which enhanced heterogeneously and had a peripheral enhancing capsule-like structure. An approximately 1.5-cm hypervascular nodule was visible in the mass during the hepatic arterial phase (Fig. 1A). No peripancreatic infiltration or direct invasion of neighboring organs was observed. The main pancreatic duct was not visible, and no lymphadenopathy was observed. For further evaluation, MR imaging and MR cholangiopancreatography were performed. The tumor appeared heterogeneously hyperintense on T2-weighted MR images, except for the heterogeneously hypointense nodule located within the mass (Fig. 1B). On contrast-enhanced T1-weighted MR images during the hepatic arterial phase and portal venous phase, the tumor showed heterogeneous enhancement with multiple well or poorly enhancing areas relative to the normal pancreas (Fig. 1C). The nodule within the mass was also strongly enhanced, while the peripheral capsule-like structure was not visible. On MR cholangiopancreatography (TR/TE = 2,050/938), the tumor appeared hyperintense with multiple hypointense nodular lesions (Fig. 1D). An endoscopic ultrasonography revealed a well-defined, homogeneous hypoechoic mass with small cystic lesions in the pancreas tail. A PET-CT revealed that the mass showed signs of hypermetabolic activity.


Imaging findings in a case of mixed acinar-endocrine carcinoma of the pancreas.

Chung WJ, Byun JH, Lee SS, Lee MG - Korean J Radiol (2010)

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 = spleenF. 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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864868&req=5

Figure 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 = spleenF. 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).
Mentions: On the CT scans, the tail of the pancreas, covering approximately half of the longest pancreatic axis, was replaced by a heterogeneously hypoattenuating mass-like lesion which enhanced heterogeneously and had a peripheral enhancing capsule-like structure. An approximately 1.5-cm hypervascular nodule was visible in the mass during the hepatic arterial phase (Fig. 1A). No peripancreatic infiltration or direct invasion of neighboring organs was observed. The main pancreatic duct was not visible, and no lymphadenopathy was observed. For further evaluation, MR imaging and MR cholangiopancreatography were performed. The tumor appeared heterogeneously hyperintense on T2-weighted MR images, except for the heterogeneously hypointense nodule located within the mass (Fig. 1B). On contrast-enhanced T1-weighted MR images during the hepatic arterial phase and portal venous phase, the tumor showed heterogeneous enhancement with multiple well or poorly enhancing areas relative to the normal pancreas (Fig. 1C). The nodule within the mass was also strongly enhanced, while the peripheral capsule-like structure was not visible. On MR cholangiopancreatography (TR/TE = 2,050/938), the tumor appeared hyperintense with multiple hypointense nodular lesions (Fig. 1D). An endoscopic ultrasonography revealed a well-defined, homogeneous hypoechoic mass with small cystic lesions in the pancreas tail. A PET-CT revealed that the mass showed signs of hypermetabolic activity.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

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.

Show MeSH
Related in: MedlinePlus