A Case Report of Acinar Cell Carcinoma of the Pancreas Showing Rapid Growth of Liver Metastasis after Curative Pancreatectomy

Jiro Nasu, Shoichi Hishinuma, Jiro Ando, Iwao Ozawa, Junich Matsui, Takao Inada, Hideaki Shimizu, Kenjiro Kotake, Yoshiro Ogata, Joji Imura*

Department of Surgery and Department of Pathology*, Tochigi Cancer Center

A 54-year-old woman was admitted to our center with a mass in the right upper abdomen. Computed tomography (CT) revealed a huge tumor located in the head of the pancreas. The patient underwent pancreaticoduodenectomy with combined resection of the portal vein. The tumor, measuring 11×8×6 cm, was well-encapsulated and was histologically diagnosed as acinar cell carcinoma of the pancreas. Immunochemical staining of the cancer cells was positive for proteinase inhibitors. Electron microscopy showed zymogen granules, which confirmed the diagnosis of acinar cell carcinoma. All surgical margins were free of tumor, and no lymph node metastases were identified by histological examination. The patient had been well until eight months after the operation, when a large liver metastasis, which was not shown on CT scans three months earlier, was manifested. The liver metastasis was treated by transcatheter arterial embolization, but it continued to grow. The patient died of hepatic failure nine months after the operation. Autopsy revealed the solitary liver metastasis, 15 cm in diameter, and the residual pancreas was totally replaced by tumor. Encapsulated acinar cell carcinomas of the pancreas are generally considered to carry a good prognosis, but this case suggests that even such tumors have a high risk of recurrence following resection. It should be kept in mind that untreatable recurrence can soon follow removal of the tumor.

Key words
acinar cell carcinoma, pancreas, liver metastasis

Reprint requests
Jiro Nasu Department of Surgery, Tochigi Cancer Center
4-9-13 Yohnan, Utsunomiya City, 320 JAPAN

Accepted
March 8, 1995

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