title: Intraductal polypoid growth variant of pancreatic acinar cell carcinoma metastasizing to the intrahepatic bile duct 6 years after surgery: a case report and literature review.
abstract: We present the first reported case of intraductal polypoid growth (IPG) variant of pancreatic acinar cell carcinoma (ACC) metastasizing to the intrahepatic bile duct. A 58-year-old Japanese woman had previously presented with obstructive jaundice and a 7.0 cm mass in the pancreatic head. She underwent biliary drainage for 2 months followed by pancreatectomy. Histological examination revealed a carcinoma with acinar pattern, immunohistochemically positive for trypsin, and acinar cell carcinoma was diagnosed. IPGs were prominent in the main pancreatic duct and its tributaries, extending into the intrapancreatic bile duct with tumor casts in the lumen. Imaging examinations 6 years later revealed a growing lesion within the intrahepatic bile duct. Needle biopsy examination suggested metastasis of ACC, and she underwent chemoradiation therapy and partial hepatectomy. Histological examination demonstrated ACC confined to the intrahepatic bile duct. The localization of metastasis and slow growth may indicate indolent biologic behavior of the IPG variant.
authors.affiliation: Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
authors.forename: Shigenori
authors.initials: S
authors.lastname: Nagata
authors.forename: Miki
authors.initials: M
authors.lastname: Tomoeda
authors.forename: Chiaki
authors.initials: C
authors.lastname: Kubo
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshizawa
authors.forename: Michiko
authors.initials: M
authors.lastname: Yuki
authors.forename: Masanori
authors.initials: M
authors.lastname: Kitamura
authors.forename: Akemi
authors.initials: A
authors.lastname: Takenaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uehara
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Katayama
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Nakanishi
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tomita
mesh_terms: D001650:Bile Duct Neoplasms / Q000556:secondary* / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D018267:Carcinoma, Acinar Cell / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology*