Introduction

Acinar cell carcinoma is a rare epithelial neoplasm of the pancreas that shows
evidence of acinar differentiation, occasionally with an endocrine component.
Although acinar cells make up most of the pancreatic parenchyma, acinar cell
carcinoma represents approximately 1% of exocrine pancreatic tumors. With few
exceptions, acinar cell carcinoma occurs during the fifth to seventh decades of life.
Pancreatic acinar cell carcinomas are relatively aggressive neoplasms; the prognosis
of patients with acinar cell carcinomas is better than that of patients with ductal-type
adenocarcinomas but worse than that of patients with pancreatic endocrine tumors.
Most acinar cell carcinomas present with non-specific symptoms which are
related to the mass effect of the neoplasm. Common non-specific symptoms include
weight loss (52 %), abdominal pain (32 %), nausea and vomiting (20 %), melena
(12 %), and weakness, anorexia or diarrhoea (8 %). In contrast to ductal
adenocarcinoma, acinar cell carcinoma rarely results in bile duct obstruction and
jaundice, which occurs only in 12 % of patients. Bile duct obstruction is rare in acinar
cell carcinoma because they generally push rather than infiltrate into adjacent
structures.
Although the acinar cell carcinoma has been long recognized as a distinct
clinicopathologic entity, analysis of their CT and MRI features has not been reported.
Pancreatic acinar cell carcinoma typically has a large size when detected, with a
diameter > 10 cm and lesions with a diameter < 2 cm are rarely detected. Case reports
have described the CT appearances of acinar cell carcinoma as a poorly defined,
dense mass, a well-defined mass with central necrosis, a cystic mass surrounded by a
thick hypervascular wall, a well-defined hypodense mass with a thin, enhancing
capsule, and a well-defined, hypervascular solid mass. Ductal obstruction may be
either mild or absent in ACC located in the pancreatic head and this features may be
used to differentiate from pancreatic duct adenocarcinoma

Case report
A woman, 51 years old, came with chief complaint of painless, growing mass on right
upper quadrant since 1 year. Patient denied any vomit, or changes on bowel pattern.
Patient reported history of diabetes mellitus and was given insulin therapy. Physical
examination revealed a palpable solid, immobile mass in right hypochondrium region
approximately 7x7cm. There was no icteric in skin or sclera. Further examination
including laboratory, oesophago-maag-duodenography and abdominal CT scan were
perfomed.

The laboratory data were as follows: white blood cell (WBC) count, 4.6 × 109/L;
hemoglobin (Hgb), 7.7 g/L; AFP <0.50 ng/mL; carcinoembryonic antigen (CEA),
7.96 ng/mL (normal: 0–5.0 ng/mL); carbohydrate antigen 19–9 (CA 19–9) 70.79
U/mL; Amylase 214.0 U/L, GDP 264 ug/L, HbA1c 15.9
Oesophagography-Maag-Duodenography:
Filling defect was seen in
duodenum,with C-loop sign
appearance
There was no extravasation of
contrast or additional shadow

Oesophagography was unremarkable

Impression:
Suspect pancreatic head mass

Ultrasonography :
Abdominal contrast enhanced CT scan with results as followed:
Heterogen mass suspected from head of pancreas (27-40HU) lobulated, with distinct
margin, no calcification with size of -/+ 9.6x7.6x8.8cm and heterogen enhancement
(31-65HU) after contrast

Based on these results, a diagnosis of pancreatic neoplasm was suspected. Exploration

laparatomy was performed on this patient and the surgeon found a mass embedded on
the superior C loop duodenum and the root of superior mesenteric artery, colical vein
and artery. The mass was unresectable and tissues sample were taken for biopsy.
Pancreatic Acinar cell carcinoma was confirmed by postoperative pathology, with no
metastatic lymph nodes found. The patient was scheduled for chemotherapy