CT and MRI features of acinar cell carcinoma of the pancreas with pathological correlations

Hsu, Ming-Yi; Pan, Kuang-Tse; Chu, Sung‐Yu; Hung, Chih Ming; Wu, Ren‐Chin; Tseng, Jeng‐Hwei

doi:10.1016/j.crad.2009.11.010

Cited by 45 publications

(45 citation statements)

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“…Since there are few case reports and case series of ACC, its clinical and imaging features, treatment and outcomes have not been fully investigated (9-11). Hsu et al summarized the radiological findings of six cases of ACC (3). In that series, most the lesions were distributed in the pancreatic head, with a tumor size ranging from 3.5 to 12 cm.…”

Section: Discussionmentioning

confidence: 99%

“…With respect to differentiating this tumor from other pancreatic masses, such as neuroendocrine tumors, pancreatoblastoma and solid pseudopapillary neoplasms, electron microscopy is sometimes required to identify zymogen granules. To date, only a few studies have reported the imaging appearance of ACC (3,4). Since the radiologic and blood flow patterns of ACC are generally nonspecific, it is often difficult to diagnose the condition based on only imaging studies.…”

Section: Introductionmentioning

confidence: 99%

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Sudden Disappearance of the Blood Flow in a Case of Pancreatic Acinar Cell Carcinoma

et al. 2014

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A 55-year-old man was referred to our hospital for a further examination of a pancreatic cystic tumor with a solid component exhibiting vascularity. A few days later, the patient was admitted with a complaint of sudden severe epigastric pain. Enhanced CT showed the loss of vascularity in the tumor. In particular, contrastenhanced endoscopic ultrasonography (EUS) clearly demonstrated the disappearance of the blood flow, and a histological examination revealed acinar cell carcinoma with central necrosis. To our knowledge, this is the first case in the literature of acinar cell carcinoma associated with the sudden disappearance of vascularity. In this case, contrast-enhanced harmonic EUS was especially useful for assessing the degree of vascularity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sudden Disappearance of the Blood Flow in a Case of Pancreatic Acinar Cell Carcinoma

et al. 2014

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“…The imaging diagnosis of ACC varies owing to the rarity of the disease: a well-marginated, large, solid mass with a varied degree of cystic components; thin enhancing capsule; occasional central calcification; intralesional haemorrhage and less intense enhancement than a normal pancreas on both CT and MRI [4,5]. ACC is unique among pancreatic tumours as it is characterised by increased AFP levels.…”

Section: Discussionmentioning

confidence: 99%

Acinar cell carcinoma with fatty change arising from the pancreas

Chung

Park²,

Dw³

2011

BJR

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ABSTRACT. Acinar cell carcinoma of the pancreas is a rare malignant tumour developing from acinar cells, accounting for approximately 1% of pancreatic exocrine tumours. We experienced a case of an acinar cell carcinoma with fatty change. To the best of our knowledge, this is the first case report of an acinar cell carcinoma with fatty change in the clinical literature. Acinar cell carcinoma (ACC) of the pancreas is a malignant tumour developing from acinar cells. It is a rare tumour accounting for approximately 1% of pancreatic exocrine tumours. ACC with fatty change is extremely rare in the literature. This is a report on a 72-year-old female who was found to have ACC with fatty change. Case reportA 72-year-old female underwent a partial gastrectomy with Billroth I for early gastric cancer in September 2009. When a pancreatic mass was found during the 6-month follow-up CT, the patient was admitted for further investigation.Test results showed elevated levels of alpha-fetoprotein (AFP): 1945 IU ml 21 (normal range: 0-7 IU ml 21) and normal levels of cancer antigen 19-9: 8.5 U ml 21 (normal range: 0-37 U ml 21) and carcinoembryonic antigen (CEA): 2.31 ng ml 21 (normal range: 0-5 ng ml 21). An abdominal ultrasound showed a 2.5-cm hypoechoic mass in the neck of the pancreas. The mass was illdelimitated and heterogeneous. Contrast-enhanced CT showed a 2.5-cm mass in the neck of the pancreas with distal pancreatic duct dilatation and parenchymal atrophy. The mass was adjacent to the portal vein and showed less intense enhancement than the pancreas. No dilatation of the bile ducts, focal hepatic lesions or abdominal lymphadenopathies was found. The initial differential diagnoses were pancreatic cancer and metastasis.Positron emission tomography (PET) showed no significant increase in fluorodeoxyglucose (FDG) uptake. MRI showed a 2.5-cm hypovascular well-defined mass at the neck of the pancreas with distal pancreatic duct dilatation and parenchymal atrophy. This mass had low signal intensity at T 2 weighted imaging with fat suppression, and had a fat component at in-phase and outof-phase images (Figure 1). The portal vein was compressed and displaced by the mass, which remained permeable without invasion.A Whipple procedure was performed on the patient. The specimen revealed an ill-defined lobulating mass of 1.961.7 cm, which was confined to the pancreas. Histologically, the mass showed an acinar pattern of cells with nucleoli ( Figure 2). The tumour cells showed extensive and various degrees of clear cell change and microvesicular and macrovesicular fatty change. The tumour cells showed strong and diffuse immunoreactivity for AFP and were negative for CD56, chromogranin A and synaptophysin. Pathological diagnosis was ACC with fatty change.

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“…At contrast-enhanced MR the lesion exhibited a mild and inhomogeneous enhancement in the arterial phase which could be appreciated despite the presence of motion artifacts ( Figure 3A) with a rim of peripheral enhancement in the delayed phase ( Figure 3B). Although similar enhancement patterns can also be observed in other neoplastic pancreatic lesions such as the acinar cell carcinoma [15] and the solid pseudopapillary tumor [16] , MR findings were finally considered consistent with the diagnosis of a pancreatic vipoma as the patient had the typical symptoms of the Verner-Morison syndrome [2] and most vipomas are indeed localized at the level of the pancreatic tail [7] . As the tumor was prospectively missed on contrastenhanced multi-detector CT, the present case underscores the relevance of a multidisciplinary approach in the detection of pancreatic neuro-endocrine tumors and the superior contrast resolution of MR which turns out to be particularly helpful whenever the administration of iodinated contrast media is either contraindicated or suboptimal [17] .…”

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confidence: 87%

Contrast enhanced multi-detector CT and MR findings of a well-differentiated pancreatic vipoma

Camera

Severino

Faggiano

et al. 2014

WJR

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Core tip: Pancreatic vipoma is an extremely rare tumor accounting for less than 2% of endocrine pancreatic neoplasms. While cross-sectional imaging findings are usually not specific, exact localization of the tumor by means of either computed tomography (CT) or magnetic resonance (MR) is pivotal for surgical planning. We report the case of a 70 years old female with a two years history of watery diarrhoea who was found to have a solid, inhomogeneously enhancing lesion at the level of the pancreatic tail at Gadolinium-enhanced MR. The tumor had been prospectively overlooked at a contrast-enhanced multi-detector CT but it was subsequently confirmed by somatostatin-receptor scintig- CASE REPORT

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CT and MRI features of acinar cell carcinoma of the pancreas with pathological correlations

Cited by 45 publications

References 12 publications

Sudden Disappearance of the Blood Flow in a Case of Pancreatic Acinar Cell Carcinoma

Sudden Disappearance of the Blood Flow in a Case of Pancreatic Acinar Cell Carcinoma

Acinar cell carcinoma with fatty change arising from the pancreas

Contrast enhanced multi-detector CT and MR findings of a well-differentiated pancreatic vipoma

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