Curative resection of a primarily unresectable acinar cell carcinoma of the pancreas after chemotherapy
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Open Access
Case report
Curative resection of a primarily unresectable acinar cell carcinoma of the pancreas after chemotherapy Marius Distler*1, Felix Rückert1, Dag D Dittert2, Christian Stroszczynski3, Frank Dobrowolski1, Stephan Kersting1 and Robert Grützmann1 Address: 1Department of General-, Thoracic- and Vascular Surgery, University of Dresden, Dresden, Germany, 2Department of Pathology, University of Dresden, Dresden, Germany and 3Department of Radiology, University of Dresden, Dresden, Germany Email: Marius Distler* - [email protected]; Felix Rückert - [email protected]; Dag D Dittert - [email protected]; Christian Stroszczynski - [email protected]; Frank Dobrowolski - [email protected]; Stephan Kersting - [email protected]; Robert Grützmann - [email protected] * Corresponding author
Published: 25 February 2009 World Journal of Surgical Oncology 2009, 7:22
doi:10.1186/1477-7819-7-22
Received: 30 October 2008 Accepted: 25 February 2009
This article is available from: http://www.wjso.com/content/7/1/22 © 2009 Distler et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract 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. Case presentation: 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. Conclusion: 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.
Background Acinar cell carcinoma (ACC) of the pancreas is a
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