未经证实:胰腺腺泡细胞癌(ACC)是一种罕见的胰腺癌亚型(发病率,0.5-2%),流行病学和预后不清楚。有时候,复发需要重复切除,包括全胰腺切除术。我们报告了一例胰腺远端切除术后残留胰头中复发的ACC病例,该病例在nab-紫杉醇(nab-PTX)和吉西他滨(GEM)联合治疗后通过残留胰腺切除术成功治愈。
方法:一名64岁女性接受胰腺肿瘤治疗。CT显示胰腺体内有一个46毫米的肿瘤,超声内镜引导下细针穿刺(EUS-FNA)提示ACC。行胰体切除术,最终诊断为ACC。18个月后的CT显示,EUS-FNA显示残余胰头中的34毫米肿瘤为ACC。门静脉浸润明显,所以nab-PTX和GEM进行了新辅助化疗,并进行残余胰腺切除术(全胰腺切除术)。超过6个月后无复发或远处转移。
未经评估:ACC的平均生存时间为18-47个月,与胰腺导管腺癌(PDAC)相比,预后良好。ACC倾向于沿着主胰管延伸和生长,这将复发率提高到50-60%。EUS和EUS-FNA可用于评估肿瘤的扩展和诊断。包括全胰腺切除术在内的重复胰腺切除术是可行的,可以安全地进行。
结论:ACC的预后优于PDAC,但复发率更高。包括残余全胰腺切开术和化疗在内的积极手术切除可用于治疗ACC。
UNASSIGNED: Acinar cell carcinoma (ACC) of the pancreas is a rare pancreatic cancer subtype (incidence, 0.5-2%) with unclear epidemiology and prognosis. Sometimes, repeat resection including total pancreatectomy is required for recurrence. We report a
case of ACC recurring in the remnant pancreatic head after distal pancreatectomy that was successfully cured by remnant pancreatic resection following combination therapy with nab-paclitaxel (nab-PTX) and gemcitabine (GEM).
METHODS: A 64-year-old woman was referred for pancreatic tumour treatment. CT revealed a 46-mm tumour in the pancreatic body, and endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) indicated ACC. Distal pancreatectomy was performed, and the final diagnosis was ACC. CT 18 months later showed a 34-mm tumour in the remnant pancreatic head revealed as ACC by EUS-FNA. Portal vein invasion was apparent, so neoadjuvant chemotherapy with nab-PTX and GEM was administered, and remnant pancreatic resection (total pancreatectomy) was performed. No recurrence or distant metastasis was present more than 6 months later.
UNASSIGNED: Mean survival time for ACC is 18-47 months, and prognosis is good compared with pancreatic ductal adenocarcinoma (PDAC). ACC tends to extend and grow along the main pancreatic duct, which increases the recurrence rate to 50-60%. EUS and EUS-FNA were useful for evaluating tumour extension and diagnosis. Repeat pancreatic resection that included total pancreatectomy was feasible and could be performed safely.
CONCLUSIONS: ACC has a better prognosis than PDAC but with a higher recurrence rate. Aggressive surgical resection that included remnant total pancreatotomy with chemotherapy was useful in treating ACC.