Pancreatic Mixed Acinar-neuroendocrine-ductal Carcinoma: A Case Report and Literature Review

• Published in: Internal Medicine Vol. 62; no. 22; pp. 3347 - 3353
• Main Authors: Sakaguchi, Ryohei, Yamada, Reiko, Nose, Kenji, Tanaka, Takamitsu, Murashima, Yumi, Tsuboi, Junya, Nakagawa, Hayato
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.11.2023; Japan Science and Technology Agency
• Subjects: acinar cell carcinoma (ACC); Adenocarcinoma; Aged, 80 and over; Carcinoma, Acinar Cell - diagnosis; Carcinoma, Acinar Cell - surgery; Carcinoma, Ductal; Carcinoma, Neuroendocrine - diagnostic imaging; Carcinoma, Neuroendocrine - genetics; Carcinoma, Neuroendocrine - pathology; Case Report; Chemotherapy; Computed tomography; Female; Humans; Internal medicine; Literature reviews; mixed acinar-neuroendocrine-ductal carcinoma; mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN); neuroendocrine carcinoma (NEC); Neuroendocrine tumors; Pancreas; Pancreatic carcinoma; pancreatic ductal adenocarcinoma (PDAC); Pancreatic Neoplasms; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - genetics; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; mixed acinar-neuroendocrine-ductal carcinoma; mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN); pancreatic ductal adenocarcinoma (PDAC); neuroendocrine carcinoma (NEC); acinar cell carcinoma (ACC); chemotherapy
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.1298-22

Pancreatic mixed neoplasms are very rare. We herein report a unique case of pancreatic mixed acinar-neuroendocrine-ductal carcinoma with trilineage differentiation. The patient was an 83-year-old woman referred to our hospital due to anemia and a pancreatic mass. Contrast-enhanced computed tomography revealed a 60-mm mass in the pancreas. Subtotal stomach-preserving pancreaticoduodenectomy was performed. The postoperative pathological diagnosis was mixed acinar-neuroendocrine-ductal carcinoma. Postoperative chemotherapy was conducted according to the adenocarcinoma and neuroendocrine carcinoma protocols. The patient died 26 months postoperatively. Choosing appropriate chemotherapy for mixed neoplasms is difficult. Cancer gene panel testing, if possible, may support the choice of therapeutic agents.