Abstract
The incidence of acinar cell carcinoma has been reported to be about 1% of all pancreatic neoplasms, and pancreatic cancer combined with tumor growth extending into the portal vein is a rare condition. We herein report a case of acinar cell carcinoma of the pancreas with a tumor thrombus extending into the main portal trunk. Preoperative imaging of the portal vein, consisting of computed tomography (CT), magnetic resonance imaging (MRI), and angiography, revealed an oval shadow defect in the main portal trunk along with an irregular mass in the pancreatic head. At operation, we confirmed a tumor thrombus extending from a tumor in the pancreatic head into the main portal trunk via the pancreatoduodenal veins. A pancreatoduodenectomy combined with partial resection of the portal vein was thus performed under a temporary portal vein shunt from the ileocecal vein to the umbilical vein. Immunohistochemical examination for α1-antichimotrypsin and electron microscopic examination confirmed the diagnosis of acinar cell carcinoma of the pancreas with a tumor thrombus in the portal vein. Surgical excision combined with portal vein resection may therefore improve the prognosis of selected patients with portal tumor thrombus.
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References
Subramanyam BR, Balthazar EJ, Lefleur RS, Horii SC, Hulnick DH (1984) Portal venous thrombosis: Correlative analysis of sonography, CT, and angiography. Am J Gastroenterol 79:773–776
Mathieu D, Vasile N, Grenier P (1985) Portal thrombosis: Dynamic CT features and course. Radiology 154:737–741
Zirinsky K, Markisz JA, Rubenstein WA, Cahill PT, Knowles RJR, Auh YH, Morrison H, Kazam E (1988) MR imaging of portal venous thrombosis: Correlation with CT and sonography. AJR 150:283–288
Levy HM, Newhouse JH (1988) MR imaging of portal vein thrombosis. AJR 151:283–286
Charles SM, Issac RF (1992) CT of portal venous occlusion. AJR 159:717–726
Mathieu D, Grenier P, Larde D, Vasile N (1984) Portal vein involvement in hepatocellular carcinoma: Dynamic CT features. Radiology 152:127–132
Takayasu K, Tajiri H, Noguchi M, Ishikawa T, Maruyama K (1989) Imaging diagnosis of portal tumor thrombus secondary to gastric cancer. Gastrointest Radiol 14:161–163
Araki H, Suda K, Sekikawa T, Ishii Y, Hihara T, Kachi K (1990) Portal venous tumor thrombosis associated with gastric adenocarcinoma. Radiology 174:811–814
Bok EJ, Cho KJ, Williams DM, Brady TM, Weiss CA, Forrest ME (1984) Venous involvement in islet cell tumors of the pancreas. AJR 142:319–322
Watase M, Sakon M, Monden M, Miyoshi Y, Tono T, Ichikawa T, Kubota N, Shiozaki H, Okuda H, Okamura J, Mori T (1992) A case of splenic vein occlusion caused by the intravenous tumor thrombus of nonfunctioning islet cell carcinoma. Surg Today 22:62–65
Buranasiri S, Baum S (1972) The significance of the venous phase of celiac and superior mesenteric arteriography in evaluating pancreatic carcinoma. Radiology 102:11–20
Terada T, Hoso M, Nakanuma Y, Ohta T, Makino H (1989) Extrahepatic portal venous obstruction of different pathogenesis in pancreatic diseases: Reports of 4 autopsy cases with chronic pancreatitis and pancreatic carcinoma. Gastroenterol Jpn 24:414–420
Belli AM, Jennings CM, Nakielny RA (1990) Splenic and portal venous thrombosis: A vascular complication of pancreatic disease demonstrated on computed tomography. Clin Radiol 41:13–16
Hasegawa H, Nimura Y, Hayakawa N, Kamiya J, Toyoda S, Iyomasa Y, Morise K, Kato H, Saga S (1982) A resected case of large pancreatic acinar cell carcinoma (in Japanese). Nippon Shoukakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 15:1817–1820
Webb JN (1977) Acinar cell neoplasms of the exocrine pancreas. J Clin Path 30:103–112
Kaibara N, Kimura O, Nishida H (1985) High incidence of liver metastasis in gastric cancer with medullary growth pattern. J Surg Oncol 28:195–198
Cubilla AL, Fitzgerald PJ (1975) Morphological patterns of primary nonendocrine human pancreas carcinoma. Cancer Res 35:2234–2248
Schron DS, Mendelsohn G (1983) Pancreatic carcinoma with duct, endocrine, and acinar differentiation: A histologic, immunocytochemical, and ultrastructural study. Cancer 54:1766–1770
Morohoshi T, Kanda M, Horie A, Chott A, Dreyer T, Klöppel G, Heitz PU (1987) Immunocytochemical markers of uncommon pancreatic tumors: Acinar cell carcinoma, pancreatoblastoma, and solid cystic (papillary-cystic) tumor. Cancer 59:739–747
Klöppel G, Morohoshi T, John HD, Oehmichen W, Opitz K, Angelkort A, Lietz H, Rückert K (1981) Solid and cystic acinar cell tumour of the pancreas. Virchows Arch [Pathol Anat] 392:171–183
Nakao A, Nonami T, Harada A, Kasuga T, Takagi H (1990) Portal vein resection with a new antithrombogenic catheter. Surgery 108:913–918
Nakao A, Takagi H (1993) Isolated pancreatectomy for pancreatic head carcinoma using catheter bypass of the portal vein. Hepatogastroenterology 40:426–429
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Ueda, T., Ku, Y., Kanamaru, T. et al. Resected acinar cell carcinoma of the pancreas with tumor thrombus extending into the main portal vein: Report of a case. Surg Today 26, 357–360 (1996). https://doi.org/10.1007/BF00311607
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DOI: https://doi.org/10.1007/BF00311607