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

Kim CY, Lee SH, Jeon HM, Kim HK, Kang CM, Lee WJ - Korean J Hepatobiliary Pancreat Surg (2014)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, 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.

No MeSH data available.


Related in: MedlinePlus

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).
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Figure 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).

Mentions: A 72-year-old female patient was admitted to our hospital for the evaluation and proper management of a pancreatic mass. Six months ago, she underwent a radical subtotal gastrectomy with gastroduodenostomy (Billroth I) due to early gastric cancer. This pancreatic mass was incidentally identified on a postoperative follow-up abdominal-pelvic computed tomography (CT) scan. Her body weight was 39 kg and the height was 144 cm (body mass index, 18.8). A physical examination finding was an upper midline abdominal skin incision in the abdomen, which was soft and flat without palpable mass. All routine blood laboratory tests including amylase and lipase were within normal ranges. Also tumor markers, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and carbohydrate antigen 125 (CA 125) were within normal limits. In the CT scan, an approximately 2.5 cm-sized mass near the neck of the pancreas with distal duct dilatation and a parenchyma atrophic change abutting to the portal vein was identified. No lymph node enlargement or distant metastasis was detected (Fig. 1A).The 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) positron emission tomography (PET) showed approximately 2.6 cm-sized low-attenuating pancreatic mass in the body portion without significantly increased FDG uptake in any other organs (Fig. 1B). Pancreaticobiliary magnetic resonance imaging with cholangiography showed about 2.5 cm-sized hypervascular, T2 low signal, fat-containing, well-defined mass in the neck area with distal parenchymal atrophy and duct dilatation (Fig. 1C). The characteristics of the tumor seemed to be somewhat different from usual ductal adenocarcinoma of the pancreas, and serum AFP was checked. It was elevated to 2,254.1 IU/ml (reference range: 0-7.0 IU/ml).


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

Kim CY, Lee SH, Jeon HM, Kim HK, Kang CM, Lee WJ - Korean J Hepatobiliary Pancreat Surg (2014)

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

License
Show All Figures
getmorefigures.php?uid=PMC4492330&req=5

Figure 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).
Mentions: A 72-year-old female patient was admitted to our hospital for the evaluation and proper management of a pancreatic mass. Six months ago, she underwent a radical subtotal gastrectomy with gastroduodenostomy (Billroth I) due to early gastric cancer. This pancreatic mass was incidentally identified on a postoperative follow-up abdominal-pelvic computed tomography (CT) scan. Her body weight was 39 kg and the height was 144 cm (body mass index, 18.8). A physical examination finding was an upper midline abdominal skin incision in the abdomen, which was soft and flat without palpable mass. All routine blood laboratory tests including amylase and lipase were within normal ranges. Also tumor markers, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and carbohydrate antigen 125 (CA 125) were within normal limits. In the CT scan, an approximately 2.5 cm-sized mass near the neck of the pancreas with distal duct dilatation and a parenchyma atrophic change abutting to the portal vein was identified. No lymph node enlargement or distant metastasis was detected (Fig. 1A).The 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) positron emission tomography (PET) showed approximately 2.6 cm-sized low-attenuating pancreatic mass in the body portion without significantly increased FDG uptake in any other organs (Fig. 1B). Pancreaticobiliary magnetic resonance imaging with cholangiography showed about 2.5 cm-sized hypervascular, T2 low signal, fat-containing, well-defined mass in the neck area with distal parenchymal atrophy and duct dilatation (Fig. 1C). The characteristics of the tumor seemed to be somewhat different from usual ductal adenocarcinoma of the pancreas, and serum AFP was checked. It was elevated to 2,254.1 IU/ml (reference range: 0-7.0 IU/ml).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, 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.

No MeSH data available.


Related in: MedlinePlus