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

Q: What diagnosis was confirmed after surgery in this case?

The postoperative pathological diagnosis was pancreatic mixed acinar-neuroendocrine-ductal carcinoma with trilineage differentiation.

Q: How did the patient initially present, and what did imaging show?

The 83-year-old woman was referred for anemia and a pancreatic mass. Contrast-enhanced CT revealed a 60-mm pancreatic mass with heterogeneous enhancement and associated main pancreatic duct dilation.

Sep 24, 2026

Upload by Anna Hans

Pancreatic mixed neoplasms are extremely rare, and this case report describes a pancreatic mixed acinar-neuroendocrine-ductal carcinoma with trilineage differentiation. An 83-year-old woman presented with anemia and a pancreatic mass, and contrast-enhanced CT showed a 60-mm lesion. Subtotal stomach-preserving pancreaticoduodenectomy was performed; pathology confirmed the mixed diagnosis and adjuvant chemotherapy followed protocols for adenocarcinoma and neuroendocrine carcinoma. The patient died 26 months after surgery, highlighting the difficulty of selecting appropriate chemotherapy for mixed neoplasms and the potential value of gene panel testing.

LanguageEnglish

CategoryHealthcare

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Pages7

Reading Time18 min

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Abstract

Introduction

Case Report

doi: 10.2169/internalmedicine.1298-22 Intern Med 62: 3347-3353, 2023 [http://internmed.jp](http://internmed.jp) 【CASE REPORT】 | Pancreatic Mixed Acinar-neuroendocrine-ductal Carcinoma: A Case Report and Literature Review | | | --- | --- | | Ryohei Sakaguchi 1,2, Reiko Yamada 1, Kenji Nose 1, Takamitsu Tanaka 1, Yumi Murashima 1,
Junya Tsuboi 1 and Hayato Nakagawa 1 | | | Abstract:
Pancreatic mixed neoplasms are very rare. We herein report a unique case of pancreatic mixed acinarneuroendocrine-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.
Key words: mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN), mixed acinar-neuroendocrineductal carcinoma, neuroendocrine carcinoma (NEC), acinar cell carcinoma (ACC), pancreatic ductal adenocarcinoma (PDAC), chemotherapy
(Intern Med 62: 3347-3353, 2023)
(DOI: 10.2169/internalmedicine.1298-22) | | |
Introduction | mixed neoplasms are listed under World Health Organization (WHO) classifications as carcinomas with mixed differentiation, including mixed acinar-endocrine, mixed acinar- | | Pancreatic neoplasms are a diverse group of tumors that | endocrine-ductal, and mixed acinar-ductal carcinomas (2, 3) . | | generally have a poor prognosis. Based on their histology, | The mixed neuroendocrine-non-neuroendocrine neoplasm | | they are classified into exocrine and endocrine neoplasms | (MiNEN) have similar pathological characteristics to these | | according to the cells of origin (ductal and acinar cells vs. islet of Langerhans) . Exocrine pancreatic neoplasms account | mixed neoplasms. According to the WHO classification system, MiNENs are a mixture of exocrine and endocrine tu- | | for the majority of cases (>95%), with pancreatic ductal | mors of the pancreas, with each component comprising 􀀂 | | adenocarcinoma (PDAC) being the most predominant sub- | 30% of the tumor (8) . Mixed neoplasms with trilineage dif- | | type (80-85% of cases) (1), while acinar cell carcinoma | ferentiation are extremely rare, and there are few such case | | (ACC) is rarer and accounts for <1% of all pancreatic neo- | reports. | | plasms (2, 3) . Pancreatic neuroendocrine neoplasms (PanNENs), including neuroendocrine tumor (NET) and | We herein report a unique case of mixed acinarendocrine-ductal carcinoma with PDAC, ACC, and NEC | | neuroendocrine carcinoma (NEC), are also relatively rare | components, making it one of the rarest pancreatic neo- | | and account for 1-2% of all pancreatic neoplasms (4) . The 5-year survival rates are approximately 10% for PDAC, 40% | plasms. | | for Pan-NENs, and 44% for ACC (5-7) . | Case Report | | In general, most pancreatic tumors arise as a single cell | | | type caused by endocrine or exocrine cells. In contrast, | An 83-year-old woman was referred to our hospital for an | 1 Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Japan and 2 Department of Gastroenterology, Yokkaichi Hazu Medical Center, Japan Received: November 17, 2022; Accepted: February 26, 2023; Advance Publication by J-STAGE: April 7, 2023 Correspondence to Dr. Reiko Yamada, [reiko-t@med.mie-u.ac.jp](reiko-t@med.mie-u.ac.jp) Figure 1. Contrast-enhanced computed tomography findings. Contrast-enhanced (a) axial and (b) coronal computed tomography images showing a 60-mm mass with inhomogeneous

FAQs

What diagnosis was confirmed after surgery in this case?

The postoperative pathological diagnosis was pancreatic mixed acinar-neuroendocrine-ductal carcinoma with trilineage differentiation.

How did the patient initially present, and what did imaging show?

The 83-year-old woman was referred for anemia and a pancreatic mass. Contrast-enhanced CT revealed a 60-mm pancreatic mass with heterogeneous enhancement and associated main pancreatic duct dilation.

Why is chemotherapy selection considered difficult for mixed neoplasms, and what approach may help?

Choosing appropriate chemotherapy for mixed neoplasms is difficult because treatment needs to address mixed components. Cancer gene panel testing, if possible, may support selection of therapeutic agents.

Sep 24, 2026

Upload by Anna Hans