s-1-(combination) and Carcinoma--Acinar-Cell

Current case is the third report of S-1 chemotherapy against acinar cell carcinoma (ACC) of pancreas, and our patient has achieved the longest reported recurrence-free survival, longer than 6 years, despite the presence of disseminated nodules at laparotomy.A 77-year-old man presented with abdominal discomfort. Computed tomography showed a low-density tumor in the pancreas tail and the patient was referred for surgery. A 3-cm sized pancreatic tumor, with localized disseminated nodules, was detected on laparotomy. Distal pancreatectomy with concomitant resection of disseminated nodules was performed, and histopathological examination revealed an ACC. Oral S-1 chemotherapy was administered postsurgery, and the patient showed no sign of recurrence during 73 months of follow-up. This is the first report of long-term survivor of pancreatic ACC with peritoneal dissemination, following pancreatectomy and S-1 chemotherapy.Current case suggests a beneficial effect of S-1 chemotherapy in cases of ACC.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Acinar Cell; Drug Combinations; Humans; Male; Oxonic Acid; Pancreatic Neoplasms; Peritoneum; Tegafur

A 79-year-old woman was referred for pancreatic tail cancer with multiple liver metastases. The pancreatic tail tumor was diagnosed as acinar cell carcinoma (ACC) histologically by endoscopic ultrasound-guided fine-needle aspiration. Because of multiple liver metastases, S-1 chemotherapy was administered, resulting in a partial response to chemotherapy one year later. After approximately three years, liver atrophy and esophageal varices developed. We suspected S-1 as the cause of the liver cirrhosis. S-1 cessation minimized ascites and improved the esophageal varices. Although S-1 can potentially treat ACC, we should be watchful for liver cirrhosis caused by its long-term administration.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Acinar Cell; Drug Combinations; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; Liver Neoplasms; Oxonic Acid; Pancreatic Neoplasms; Tegafur

A 26-year-old woman underwent laparoscopic-assisted distal pancreatectomy and splenectomy for a tumor in the tail of the pancreas. Although the preoperative diagnosis was a solid pseudopapillary tumor, pathological tissue examination revealed that the tumor was a pancreatic acinar cell carcinoma. She was treated with S-1 chemotherapy for 6 months without severe side effects, and no recurrence was detected on several imaging inspections. Acinar cell carcinoma of the pancreas is a rare tumor in young patients, and there are few reports of treatment with postoperative chemotherapy.

Topics: Adult; Carcinoma, Acinar Cell; Drug Combinations; Female; Humans; Neoplasm Recurrence, Local; Oxonic Acid; Pancreas; Pancreatectomy; Pancreatic Neoplasms; Splenectomy; Tegafur

Acinar cell carcinomas (ACCs) and mixed acinar-endocrine carcinomas (MAECs) of the pancreas are rare, accounting for only 1% of pancreatic tumors. Although both typically present at an advanced stage, chemotherapeutic regimes have not yet been standardized.. A 65-year-old man presented with a large mass in the pancreatic tail with multiple liver metastases.. He was initially treated with gemcitabine for suspected ductal carcinoma of the pancreas, but no response was observed. S-1, administered as second-line chemotherapy, showed an approximately 38% reduction in the size of the primary tumor and metastatic deposits with therapeutic effects being maintained for 12 months. When the tumor progressed again, he underwent a percutaneous liver biopsy, which led to the diagnosis of MAEC. Combination therapy with cisplatin and etoposide targeting the endocrine component was administered, and this was based on the endocrine component potentially being less sensitive to S-1 than the ACC element. However, therapy was stopped due to the development of neutropenia, and the patient is currently receiving best supportive care.. Given the previous studies suggested that S-1 is more effective for ACCs than gemcitabine, MAECs may also respond to S-1 chemotherapy, similar to ACCs. Another potential interpretation is that S-1 was effective when the condition was ACC, and eventually showed decreased effectiveness when the condition shifted to MAEC. Future studies are needed to conclude whether S-1 chemotherapy truly works against MAECs or induces endocrine differentiation in ACCs as a part of the drug-resistance process.

Topics: Aged; Antineoplastic Agents; Carcinoma, Acinar Cell; Cisplatin; Deoxycytidine; Drug Combinations; Etoposide; Gemcitabine; Humans; Male; Oxonic Acid; Pancreatic Neoplasms; Tegafur

The patient was a 46-year-old woman with left lower abdominal pain.Abdominal dynamic CT revealed a 40 mm, gradually- enhanced pancreatic head mass.The interior of the tumor was heterogeneous and partly low in density.Endoscopic ultrasonography showed a well-defined and heterogeneous tumor with an echoic area in the pancreatic head.Therefore, the cystic lesion with solid components was suspected to be a solid pseudopapillary neoplasm(SPN), considering the age of the patient.Subtotal stomach-preserving pancreaticoduodenectomy was performed.The postoperative course was uneventful, and she was discharged on the 13th day after surgery.Postoperative pathology confirmed a diagnosis of pancreatic acinar cell carcinoma.SPNs often show an image very similar to pancreatic acinar cell carcinoma and it is difficult to distinguish between the two only by imaging findings.Due to the divergence between clinical findings such as age and image findings, it was difficult to confirm a diagnosis of pancreatic acinar cell carcinoma in this case.

Topics: Antimetabolites, Antineoplastic; Carcinoma, Acinar Cell; Chemotherapy, Adjuvant; Drug Combinations; Female; Humans; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Pancreaticoduodenectomy; Tegafur

Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Biopsy, Fine-Needle; Carcinoma, Acinar Cell; Carcinoma, Neuroendocrine; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Immunohistochemistry; Male; Middle Aged; Neoplasms, Complex and Mixed; Oxonic Acid; Pancreatic Neoplasms; Tegafur; Tomography, X-Ray Computed; Treatment Outcome

A 6 3-year-old man with a huge pancreatic tumor was referred to our hospital. Abdominal computed tomography revealed a heterogeneously enhanced encapsulated mass, 14 cm in diameter, in the pancreas head. The tumor thrombus extended to the bifurcation of the portal vein. The tumor, which had invaded the descending duodenum, was diagnosed as a probable case of acinar cell carcinoma, based on the biopsy results. Prior to resection, we prepared an ileocecal vein-umbilical vein bypass. Initially, we planned to perform a pancreatoduodenectomy, however, a total pancreatectomy had to be performed due to the atrophy of the residual pancreas tail. Since the tumor thrombus was visible, floating up from the portal vein wall at the upper level of pancreas, we dissected the portal vein at this level. The thrombus was extracted after securing the main tract and both (right and left) branches of the portal vein with vessel tape. About 5 cm of portal vein was resected and reconstructed. Since patients who undergo resection of acinar cell carcinoma have a better prognosis and long-term survival is often reported for cases of resected tumor thrombus of the portal vein, it is advisable to resect acinar cell carcinomas even in cases as advanced as reported here.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Acinar Cell; Chemotherapy, Adjuvant; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein; Prognosis; Tegafur; Thrombosis

Acinar cell carcinoma of the pancreas is a rare malignancy, accounting for 1-2% of pancreatic exocrine malignancies. This rarity makes it difficult to standardize a protocol of treatment for acinar cell carcinoma.. A 71-year-old male without any particular past history was referred to our institute with abdominal distention and mild liver dysfunction. Computed tomography (CT) revealed a cystic lesion with a diameter of 3.5 cm, which originated from the neck of pancreas and had solid nodules inside. Several nodules were demonstrated surrounding the cystic tumor. Laparotomy and histological study demonstrated peritoneal dissemination of acinar cell carcinoma. The patient was treated with S-1 monotherapy (80 mg/m2 for four weeks with a two-week interval as one cycle). After one cycle of S-1 monotherapy, CT demonstrated remarkable shrinkage of the main tumor and disappearance of the nodules on the peritoneum. The patient underwent a radical distal pancreatectomy. The patient was then treated with 16 cycles of S-1 monotherapy after the radical pancreatectomy and remains without any recurrence of the disease two years later.. Initially inoperable acinar cell carcinoma was treated by monotherapy using S-1, resulting in curative operation and two years disease free survival post operation. S-1 might be more effective on acinar cell carcinoma, rather than gemcitabine.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Acinar Cell; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Humans; Male; Oxonic Acid; Pancreatectomy; Pancreatic Neoplasms; Tegafur; Treatment Outcome

Pancreatic acinar cell carcinoma is rare, and its incidence is less than 1% of all the malignant pancreatic tumors. Little is reported on effectiveness of chemotherapy. We report a 64-year-old male patient with pancreatic acinar cell carcinoma and a giant metastatic liver tumor, which responded to combination chemotherapy with gemcitabine(GEM)and peroral S-1 administration. The patient had upper abdominal pain and hypervascular tumors in liver(15 cm in diameter)and pancreas tail (3 cm in diameter), which were detected by an enhanced abdominal computed tomography(CT)scan, and was admitted for further examination. Abdominal angiography, FDG-positron emission tomography(PET), and liver tumor biopsy led to a diagnosis of pancreatic acinar cell carcinoma in the pancreas tail with liver metastasis. The patient was then treated with combination chemotherapy, which consisted of intravenous infusion of GEM and peroral administration of S-1, and the metastatic liver tumor was markedly reduced(partial response in RECIST). Although the prognosis of patients with unresectable pancreatic acinar cell cancers is generally unfavorable, it is suggested that the GEM/S- 1 combination chemotherapy is effective for these patients' treatment.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy; Carcinoma, Acinar Cell; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Tegafur

A 65-year-old man underwent a total gastrectomy and distal pancreatectomy for acinar cell carcinoma of the pancreas. Multiple metastatic liver lesions were found one year postoperatively. He was treated with S-1 chemotherapy over 34 months, and the tumors significantly reduced in size without severe side effects. Four years after surgery, the liver metastases increased in size, associated with pain especially in the right upper quadrant. We then performed right hepatectomy. Peritoneal dissemination and multiple lung metastases were found 8 months after liver resection. Acinar cell carcinoma of the pancreas is a rare and highly malignant tumor, and there are few reports regarding treatment with chemotherapy. Herein, we report a case with multiple liver metastases which were controlled by systemic chemotherapy using S-1.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Acinar Cell; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Pancreatectomy; Pancreatic Neoplasms; Tegafur

A 55-year-old man underwent a pylorus-preserving pancreatoduodenectomy in August 2006 because of acinar cell carcinoma of the head of the pancreas. Since abdominal CT revealed multiple liver metastases, we started systemic chemotherapy with gemcitabine (1,400 mg/body, day 1, 8, 15/q4w) in October 2006. At the beginning of this treatment, it seemed to be a stable disease, but CT revealed tumor progression in January 2007. Despite the change to oral chemotherapy with S-1 (100 mg/body, day 1-14/q3w), tumors were markedly enlarged in March 2007. Therefore, we selected combination chemotherapy with oral S-1 and hepatic arterial infusion of CDDP (50 mg/body) as third-line. After 6 months of treatment, abdominal CT revealed marked shrinkage of tumors, accompanied by a decrease in AFP level. Though the patient died of hepatic failure in July 2009 (33 months after recurrence), he spent most of his time at home and worked as usual. We suggest that combination chemotherapy with oral S-1 and intra-arterial CDDP can be effective treatments for pancreatic acinar cell carcinoma.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Acinar Cell; Cisplatin; Drug Combinations; Fatal Outcome; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Recurrence; Tegafur; Tomography, X-Ray Computed

Pancreatic acinar cell carcinoma (ACC) is a comparatively rare tumor and account for approximately 1% of all cases of pancreatic cancer. Clinical presentation is usually related to either local spread or metastasis. The clinical features, especially those related to the prognosis and treatment outcomes, have not yet been fully clarified. There are no established treatments for unresectable pancreatic ACC. We administered gemcitabine monotherapy to four patients with ACC; however, the results were not satisfactory. Disease control without obvious tumor shrinkage was observed in one patient. Another patient showed severe renal damage caused by gemcitabine. On the other hand, fluoropyrimidine-based chemotherapy may have some activity against this tumor, because one of the three patients who received S-1 as second-line chemotherapy showed a partial response. Prospective clinical trials are necessary to confirm the effectiveness of fluoropyrimidine for the treatment of pancreatic ACC.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Acinar Cell; Deoxycytidine; Disease-Free Survival; Drug Combinations; Female; Gemcitabine; Humans; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Tegafur; Tomography, X-Ray Computed; Treatment Outcome

Pancreatic acinar cell carcinomas are rare, and little is reported on their chemotherapy. We report a 49-year old male patient with pancreatic acinar cell carcinoma and multiple liver metastases, which responded to oral TS-1 and hepatic arterial infusion of cisplatin. The patient underwent a partial hepatectomy, MCT abrasions and excision of the pancreatic tumor. Postoperative pathological studies revealed metastases of acinar cell carcinoma to the liver and lymph nodes; the primary lesion was undetermined. After surgery, the patient was treated with hepatic arterial infusion of cisplatin and oral TS-1. Metastatic tumors completely disappeared, and serum lipase decreased to normal levels. Abdominal CT one year after surgery revealed a pancreatic body tumor, which was surgically removed. Pathological studies showed primary pancreatic acinar cell carcinoma, while previous metastases remained under control. To summarize, TS-1 and cisplatin can be effective treatments for pancreatic acinar cell carcinomas.

Topics: Administration, Oral; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Acinar Cell; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Hepatectomy; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Pyridines; Tegafur