case_images: PMC6319679_01
case_images: Computed tomography scans of the patient's abdomen, (A) before and (B) after nine cycles of combined chemotherapy. Blue arrowhead = celiac trunk. Yellow arrowhead = splenic artery. Orange arrowhead = common hepatic artery. Green arrowhead = portal vein. T, tumor.
case_images: fig-1.jpg
case_images: PMC6319679_01_fig-1.jpg
case_images: f1
case_images: Caucasian male presented in September 2015 with severe, cramping, epigastric abdominal pain that radiated to his back and was associated with nausea, emesis, decreased appetite, and a 10 pound weight loss over the prior several months. Computed tomography (CT) of the abdomen (Fig. 1A) revealed a 6 cm mass in the body of the pancreas, closely adjacent to the celiac trunk, with main pancreatic duct dilation and parenchymal atrophy of the pancreatic tail. A repeat CT scan of the abdomen (Fig. 1B) showed continued partial response, with the pancreatic body mass now measuring only 2.0 x 1.3 cm (vs. 3.1 x 2.0 cm in December) and the dominant celiac lymph node now measuring only 1.7 x 1.6 cm (vs. 2.5 x 2.3 cm in December).
case_images: Trypsin immunohistochemical stain (400 x ). Peripancreatic lymph node shows strong positivity in trypsin-positive tumor cells, supporting acinar differentiation.
case_images: fig-2.jpg
case_images: PMC6319679_01_fig-2.jpg
case_images: f2
case_images: These cells showed positive staining for trypsin and negative staining for synaptophysin, chromogranin, and beta-catenin, strongly supporting the previous diagnosis of acinar cell carcinoma (Fig. 2).