Misunderstood Gastric Perforation of a Pancreatic Acinar Cell Carcinoma: A Wolf in Sheep’s Clothing

A 70-year-old man was admitted to the Emergency Department (ED) for marked asthenia and severe anemia. In addition, a high level of lipase was found. During hospitalization, a locally advanced gastric cancer was diagnosed, with endoscopic evidence of a large polyploid formation originating under the...

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Published inSurgeries Vol. 4; no. 1; pp. 73 - 85
Main Authors Cuoghi, Manuela, Baccaro, Cinzia, Zorzetti, Noemi, Fornelli, Adele, Ferrara, Francesco, Cennamo, Vincenzo, Navarra, Giuseppe Giovanni
Format Journal Article
LanguageEnglish
Published MDPI AG 01.03.2023
Subjects
gastric perforation
gastric tumor
pancreatic acinar cell carcinoma
pancreatic tumor
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Summary:A 70-year-old man was admitted to the Emergency Department (ED) for marked asthenia and severe anemia. In addition, a high level of lipase was found. During hospitalization, a locally advanced gastric cancer was diagnosed, with endoscopic evidence of a large polyploid formation originating under the cardias that occupied most of the gastric lumen. A total body CT scan was performed before surgery; the tumor affected the posterior gastric wall, with tenacious infiltration of the pancreatic body. Therefore, we performed a total gastrectomy with esophageal jejunum anastomosis and reconstruction of intestinal continuity according to Roux, distal spleno-pancreatectomy, and cholecystectomy. At histology, a pancreatic acinar cell carcinoma (PACC) with full thickness infiltration of the gastric wall was diagnosed. Acinar cell carcinomas are highly aggressive neoplasms, and surgical resection, when feasible, is the treatment of choice regardless of size, also because the role of neoadjuvant or adjuvant chemo- or radiotherapy remains uncodified.
ISSN:2673-4095
2673-4095
DOI:10.3390/surgeries4010009