Mixed Duct-Acinar Cell Carcinoma of the Pancreas: Report of a Case

Mitsuru Sakai, Shin Takeda, Tadao Ishikawa, Naohito Kanazumi, Soichiro Inoue, Tetsuya Kaneko, Akimasa Nakao and Tetsuro Nagasaka*

Department of Surgery II and Department of Pathology*, Nagoya University School of Medicine

We report a rare case of pancreatic cancer, duct-acinar cell carcinoma. The tumor was detected on CT in the pancreatic head of a 63-year-old man who had aggravated diabetes mellitus. Enhanced CT showed a solid tumor with an indistinct border and hypovascularity, 3.5 cm in diameter. Angiography showed direct invasion to the iliocecal vein. ERP showed a disrupted main pancreatic duct. Laboratory findings were unremarkable, except for serum CEA of 5.6 ng/ml and hyperglycemia. With a diagnosis of ductal invasive cancer of the pancreatic head, we conducted pancreatoduodenectomy with resection of the iliocecal vein and intraoperative radiotherapy. Histopathological examination showed that the tumor consisted of two distinct cell populations: duct and acinar cells. According to immunohistochemical analysis, duct cells were positive for CEA, whereas acinar cells were positive for amylase, trypsin, and alpha-1-antitrypsin. Both were negative for chromogranin A. These findings suggested mixed duct-acinar carcinoma of the pancreas, a very rare occurrence whose clinical and pathological features are little known. Further cases and studies are thus needed to clarify its pathogenesis.

Key words
duct-acinar cell carcinoma, pancreatic cancer

Reprint requests
Mitsuru Sakai Department of Surgery II, Nagoya University School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
May 25, 2005

To read the PDF file you will need Abobe Reader installed on your computer.