[A Case Report of Acinar Cell Carcinoma of Pancreas with Extensive Intraductal Growth to the Branch - Main Pancreatic Duct].

Since acinar cell carcinoma(ACC)of pancreas is rare, we sometimes meet a case hard to make diagnosis before surgery. We here reported a case of ACC of pancreas with extensive intraductal growth to the main pancreatic duct and the branch of the pancreatic duct. A 43-year-old man visit a clinic with a concern of uncomfortable feeling on left side abdomen. CT/MRI examination showed a ischemic tumor, 38×25 mm, in the body-tail of the pancreas, and the tumor infiltrated to left renal capsule. ERCP showed the interruption and stenosis of the pancreatic duct at the point adjacent to tumor. Cytological diagnosis of the pancreatic juice was performed, but malignant cells were not detected(Class III ). The tumor abnormally accumulated FDGin PET-CT examination(SUVmax 3.3). We diagnosed the tumor PDAC with infiltrating to the left renal capsule, and the distal pancreatectomy was performed. The pathological examination of the resected specimen showed that the tumor progressed into main pancreatic duct and the branch of the pancreatic duct accompanying with fibrosis around pancreatic duct. The tumor was diagnosed ACC with immunohistochemistry; positive to ACC phenotype(a1-antitrypsin, a1-antichymotrypsin, BCL10). The patient is alive without any recurrence findings 3 years 2 months after surgery.