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Intraductal polypoid growth variant of pancreatic acinar cell carcinoma metastasizing to the intrahepatic bile duct 6 years after surgery: A case report and literature review
Authors:Shigenori Nagata  Miki Tomoeda  Chiaki Kubo  Hidenori Yoshizawa  Michiko Yuki  Masanori Kitamura  Akemi Takenaka  Hiroyuki Uehara  Kazuhiro Katayama  Katsuyuki Nakanishi  Hidenori Takahashi  Hiroaki Ohigashi  Osamu Ishikawa  Yasuhiko Tomita
Affiliation:1. Spine and Spinal Cord Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan;2. Keio Spine Research Group, Keio University, Tokyo, Japan;3. Department of Orthopedic Surgery, School of Medicine, Keio University, 35 Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan;4. Department of Orthopedic Surgery, Murayama Medical Center, Tokyo, Japan;1. Department of Ophthalmology, Baltimore, USA;2. Department of Neuroscience, Baltimore, USA;3. Center for Nanomedicine, Baltimore, USA;4. Department of Chemical and Biomolecular Engineering, Baltimore, USA;5. GrayBug, LLC, Baltimore, USA;6. Vascular Program, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, USA;7. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA;8. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA;9. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, USA;10. Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, USA;11. Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, USA;12. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, USA;13. Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, USA;14. Department of Environmental Health Sciences, Johns Hopkins University School of Medicine, Baltimore, USA;15. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
Abstract:We present the first reported case of intraductal polypoid growth (IPG) variant of pancreatic acinar cell carcinoma (ACC) metastasizing to the intrahepatic bile duct. A 58-year-old Japanese woman had previously presented with obstructive jaundice and a 7.0 cm mass in the pancreatic head. She underwent biliary drainage for 2 months followed by pancreatectomy. Histological examination revealed a carcinoma with acinar pattern, immunohistochemically positive for trypsin, and acinar cell carcinoma was diagnosed. IPGs were prominent in the main pancreatic duct and its tributaries, extending into the intrapancreatic bile duct with tumor casts in the lumen. Imaging examinations 6 years later revealed a growing lesion within the intrahepatic bile duct. Needle biopsy examination suggested metastasis of ACC, and she underwent chemoradiation therapy and partial hepatectomy. Histological examination demonstrated ACC confined to the intrahepatic bile duct. The localization of metastasis and slow growth may indicate indolent biologic behavior of the IPG variant.
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