Total Pancreatectomy Performed in a Case of Acinar Cell Carcinoma Diagnosed One Year after Extensive Development of Acute Pancreatitis in the Main Pancreatic Duct

We herein present a case of a 65-year-old woman who was referred to our institution for evaluation of a tumor in the head and body of the pancreas. The tumor had been discovered by MRI when glucose tolerance worsened one year after conservative treatment for acute pancreatitis. CT, MRI, and endoscopic ultrasound confirmed that the tumor had invaded the main pancreatic duct. CT showed an enhanced low-density tumor in the head and body of the pancreas in the early phase, leading to diagnosis of acinar cell carcinoma (ACC). Pylorus-preserving pancreatoduodenectomy was started, but an intraoperative examination revealed severe inflammation around the pancreas due to acute and obstructive pancreatitis. Because of difficulty preserving the splenic artery and the small amount of remnant pancreas tissue, total pancreatectomy was finally performed. The pathological diagnosis was ACC. In this report, we discuss our experience with this case of total pancreatectomy for ACC characterized by intraductal spread within one year.