Curative resection of a primarily unresectable acinar cell carcinoma of the pancreas after chemotherapy.
BACKGROUND
Acinar cell carcinoma (ACC) represents only 1-2% of pancreatic cancers and is a very rare malignancy. At the time of diagnosis only 50% of the tumors appear to be resectable. Reliable data for an effective adjuvant or neoadjuvant treatment are not available.


METHODS
A 65-year old male presented with obstructive jaundice and non-specific upper abdominal pain. MRI-imaging showed a tumor within the head of the pancreas concomitant with Serum-Lipase and CA19-9. During ERCP, a stent was placed. Endosonographic fine needle biopsy confirmed an acinar cell carcinoma. Laparotomy presented an locally advanced tumor with venous infiltration that was consequently deemed unresectable. The patient was treated with five cycles of 5-FU monotherapy with palliative intention. Chemotherapy was well tolerated, and no severe complications were observed. Twelve months later, the patient was in stable condition, and CT-scanning showed an obvious reduction in the size of the tumor. During further operative exploration, a PPPD with resection of the portal vein was performed. Histopathological examination gave evidence of a diffuse necrotic ACC-tumor, all resection margins were found to be negative. Eighteen months later, the patient showed no signs of recurrent disease.


CONCLUSIONS
ACC responded well to 5-FU monochemotherapy. Therefore, neoadjuvant chemotherapy could be an option to reduce a primarily unresectable ACC to a point where curative resection can be achieved.
Distler
Marius
M
Department of General-, Thoracic- and Vascular Surgery, University of Dresden, Dresden, Germany. marius.distler@uniklinikum-dresden.de
Rückert
Felix
F
Dittert
Dag D
DD
Stroszczynski
Christian
C
Dobrowolski
Frank
F
Kersting
Stephan
S
Grützmann
Robert
R
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D018267:Carcinoma, Acinar Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil