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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

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.
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Figure 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.

Mentions: The patient underwent a pancreaticoduodenectomy (PD). During the laparotomy, malignant ascites, peritoneal seeding or distant metastasis were not found, but severe peritoneal adhesions due to the previous radical subtotal gastrectomy were noted. The anatomic plane was obscured during the PD due to the previous lymph node dissection around the celiac axis, common hepatic artery and the proper hepatic artery. Therefore, a dissection between the neck of the pancreas and superior mesenteric vein-splenic vein-portal vein confluence was needed to identify the anatomic landmark (Fig. 2A). As previous lymph node dissection around major vessels was conducted already, a standard lymph node dissection was performed (Fig. 2B). Due to the previous gastroduodenostomy the reconstruction of gastrointestinal continuity was easy following the PD. All procedures, pancreaiticojejunostomy, hepaticojejunostomy and gastrojejunostomy were completed in a usual manner.


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)

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

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

Figure 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.
Mentions: The patient underwent a pancreaticoduodenectomy (PD). During the laparotomy, malignant ascites, peritoneal seeding or distant metastasis were not found, but severe peritoneal adhesions due to the previous radical subtotal gastrectomy were noted. The anatomic plane was obscured during the PD due to the previous lymph node dissection around the celiac axis, common hepatic artery and the proper hepatic artery. Therefore, a dissection between the neck of the pancreas and superior mesenteric vein-splenic vein-portal vein confluence was needed to identify the anatomic landmark (Fig. 2A). As previous lymph node dissection around major vessels was conducted already, a standard lymph node dissection was performed (Fig. 2B). Due to the previous gastroduodenostomy the reconstruction of gastrointestinal continuity was easy following the PD. All procedures, pancreaiticojejunostomy, hepaticojejunostomy and gastrojejunostomy were completed in a usual manner.

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