Article ID: JNMS.2018_86-501
We report the case of a pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas of a 78-year-old man after pancreaticoduodenectomy for acinar cell carcinoma. Acinar cell carcinoma is a relatively rare pancreatic neoplasm. Following the diagnosis of pancreatic carcinoma, subtotal stomach-preserving pancreaticoduodenectomy was performed. The pathological diagnosis was acinar cell carcinoma of the pancreas, disease stage IA, pT1, pN0, M0, without regional lymph node invasion. Twenty-two months after the surgery, cancer antigen 19-9 levels gradually increased, and computed tomography showed 2 solid tumors, approximately 1.1 and 2.1 cm in diameter, respectively, at the site of the remnant pancreas. Endoscopic ultrasound fine-needle aspiration revealed pancreatic ductal adenocarcinoma. The tumor cells were not immunoreactive for trypsin. Both tumors were diagnosed as PDAC of the remnant pancreas. The patient refused treatment with curative resection. Thus, as an alternative treatment, chemoradiotherapy was initiated. However, 28 months after surgery, the patient succumbed to the disease. Because this is an extremely rare case, further cases and studies are needed to understand its pathogenesis.