Abstract
BackgroundPancreatic neoplasms are usually characterized by ductal, acinar, or endocrine differentiation. Mixed exocrine and endocrine pancreatic tumours are extremely rare. Here, we report a case of pancreatic mixed acinar-endocrine carcinoma (MAEC) with multiple synchronous liver metastases that were treated with surgery and transcatheter arterial chemoembolization (TACE) that later recurred in the stomach.Case presentationA 45-year-old female with severe anaemia was referred to our hospital. Computed tomography (CT) demonstrated a hypervascular tumour, 17 cm in diameter, that was in the tail of the pancreas. In addition, there were multiple hypervascular tumours in the liver. She underwent a distal pancreatectomy with splenectomy after the liver metastases were treated with TACE. Pathology confirmed that the pancreatic tumour was MAEC. After 4.5 years, a follow-up CT showed a hypervascular tumour at the upper part of the stomach. Gastric endoscopy showed a big tumefactive lesion with surface irregularities, gastric erosion, and multiple dilated vessels in the fornix and greater curvature of the stomach. She underwent a proximal gastrectomy and survived 7 years and 2 months after the start of the treatment.ConclusionsThis is the first report of a metastatic stomach tumour from pancreatic MAEC, which was successfully treated with a multidisciplinary approach. Additionally, we review the literature and discuss the treatment of MAEC.
Highlights
Pancreatic neoplasms are usually characterized by ductal, acinar, or endocrine differentiation
This is the first report of a metastatic stomach tumour from pancreatic mixed acinar-endocrine carcinoma (MAEC), which was successfully treated with a multidisciplinary approach
We report the case of a patient with pancreatic MAEC with multiple liver metastases who underwent distal pancreatectomy and catheterdirected treatment to the liver
Summary
We presented here a very rare case of metastatic gastric tumour from pancreatic MAEC with multiple liver metastasis. This is the first report of metastasis to the stomach from pancreatic MAEC. The stomach should be considered a target site of metastasis during the treatment of pancreatic MAEC. A multidisciplinary approach with surgery and TACE for liver metastases might be a promising therapeutic approach for patients with advanced cases of MAEC
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