title: Total pancreatectomy for metachronous mixed acinar-ductal carcinoma in a remnant pancreas.
abstract: In October 2009, a 71-year-old female was diagnosed with a cystic tumor in the tail of the pancreas with an irregular dilatation of the main pancreatic duct in the body and tail of the pancreas. A distal pancreatectomy with splenectomy, and partial resection of the duodenum, jejunum and transverse colon was performed. In March 2011, a follow-up computed tomography scan showed a low density mass at the head of the remnant pancreas. We diagnosed it as a recurrence of the tumor and performed a total pancreatectomy for the remnant pancreas. In the histological evaluation of the resected specimen of the distal pancreas, the neoplastic cells formed an acinar and papillary structure that extended into the main pancreatic duct. Mucin5AC, α1-antitrypsin (α-AT) and carcinoembryonic antigen (CEA) were detected in the tumor cells by immunohistochemistry. In the resected head of the pancreas, the tumor was composed of both acinar and ductal elements with a mottled pattern. The proportions of each element were approximately 40% and 60%, respectively. Strongly positive α-AT cells were detected in the acinar element. Some tumor cells were also CEA positive. However, the staining for synaptophysin and chromogranin A was negative in the tumor cells. Ultimately, we diagnosed the tumor as a recurrence of mixed acinar-ductal carcinoma in the remnant pancreas. In conclusion, we report here a rare case of repeated pancreatic resection for multicentric lesions of mixed acinar-ductal carcinoma of the pancreas.
authors.affiliation: Tatsuya Shonaka, Mitsuhiro Inagaki, Hiromitsu Akabane, Naoyuki Yanagida, Hiroki Shomura, Shiro Nakano, Division of Surgery, Hokkaido PWFAC Asahikawa-Kosei General Hospital, Asahikawa 78-8211, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Shonaka
authors.affiliation: Tatsuya Shonaka, Mitsuhiro Inagaki, Hiromitsu Akabane, Naoyuki Yanagida, Hiroki Shomura, Shiro Nakano, Division of Surgery, Hokkaido PWFAC Asahikawa-Kosei General Hospital, Asahikawa 78-8211, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Inagaki
authors.affiliation: Tatsuya Shonaka, Mitsuhiro Inagaki, Hiromitsu Akabane, Naoyuki Yanagida, Hiroki Shomura, Shiro Nakano, Division of Surgery, Hokkaido PWFAC Asahikawa-Kosei General Hospital, Asahikawa 78-8211, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Akabane
authors.affiliation: Tatsuya Shonaka, Mitsuhiro Inagaki, Hiromitsu Akabane, Naoyuki Yanagida, Hiroki Shomura, Shiro Nakano, Division of Surgery, Hokkaido PWFAC Asahikawa-Kosei General Hospital, Asahikawa 78-8211, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yanagida
authors.affiliation: Tatsuya Shonaka, Mitsuhiro Inagaki, Hiromitsu Akabane, Naoyuki Yanagida, Hiroki Shomura, Shiro Nakano, Division of Surgery, Hokkaido PWFAC Asahikawa-Kosei General Hospital, Asahikawa 78-8211, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shomura
authors.affiliation: Tatsuya Shonaka, Mitsuhiro Inagaki, Hiromitsu Akabane, Naoyuki Yanagida, Hiroki Shomura, Shiro Nakano, Division of Surgery, Hokkaido PWFAC Asahikawa-Kosei General Hospital, Asahikawa 78-8211, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yanagawa
authors.affiliation: Tatsuya Shonaka, Mitsuhiro Inagaki, Hiromitsu Akabane, Naoyuki Yanagida, Hiroki Shomura, Shiro Nakano, Division of Surgery, Hokkaido PWFAC Asahikawa-Kosei General Hospital, Asahikawa 78-8211, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Oikawa
authors.affiliation: Tatsuya Shonaka, Mitsuhiro Inagaki, Hiromitsu Akabane, Naoyuki Yanagida, Hiroki Shomura, Shiro Nakano, Division of Surgery, Hokkaido PWFAC Asahikawa-Kosei General Hospital, Asahikawa 78-8211, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakano
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D021441:Carcinoma, Pancreatic Ductal / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D019160:Endosonography; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local; D018193:Neoplasms, Complex and Mixed / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Acinar carcinoma; Mixed acinar-ductal carcinoma; Pancreatic cancer; Total pancreatectomy