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| Left abdominal mass with carcinosis: Unusual presentation of pancreatic acinar cell carcinoma |
| Davide Ciardiello a , Filomena Urbano b , Giuseppe Zamboni c , Nicola Palladino b , Francesca Bazzocchi d , Paola Parente e,∗ |
a Oncology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
b Radiology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
c Pathology Unit, Ospedale Sacro Cuore Don Calabria, vai Sempreboni, Negrar and University of Verona, Negrar 37024, VR, Italy
d Abdominal Surgical Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
e Pathology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
∗ Corresponding author.
E-mail address: paolaparente77@gmail.com (P. Parente). |
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Abstract Acinar cell carcinoma (ACC) is a rare malignant epithelial neoplasm accounting for 1%-2% of all pancreatic exocrine neoplasm, affecting more frequently man with an age between 50 and 70 years. Most patients present with nonspecific symptoms, which may give rise to difficulties in clinical diagnosis [1]. ACC can manifest with diarrhea, weight loss, abdominal pain and, in up to 10%-15%, with lipase hypersecretion syndrome, characterized by elevated lipase production, diffuse subcutaneous fat necrosis and polyarthralgia [1,2]. Biliary obstruction and jaundice are infrequent clinical manifestations, unlike ductal adenocarcinoma, due to pushing rather than infiltrating growth of ACC. This neoplasm may arise in any portion of the pancreas, with a decreasing frequency in the head, the tail, both the body and the tail/head, respectively [2]. Among the 31 cases reported, only three cases involving the whole pancreas were described [3,4]. Imaging is essential for detection and preoperative diagnosis in ACC management. Imaging features of ACC in computed tomography (CT) and magnetic resonance (MR) reveal an exophytic well-marginated mass originating from the pancreas, round to oval in shape, with a varied degree of cystic components that enhance homogeneously less than the surrounding normal pancreas [5]. Here, we describe an unusual case of left abdominal mass, infiltrating the intestinal wall, without radiologically documented connection with the pancreas, with synchronous peritoneal carcinoma, histologically corresponding to ACC.
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2023, Vol. 22 
