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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Long-term survival of two patients with recurrent pancreatic acinar cell carcinoma treated with radiofrequency ablation: A case report
Mariacristina Di Marco, Riccardo Carloni, Stefania De Lorenzo, Elisa Grassi, Andrea Palloni, Francesca Formica, Stefano Brocchi, Daria Maria Filippini, Rita Golfieri, Giovanni Brandi
Mariacristina Di Marco, Riccardo Carloni, Stefania De Lorenzo, Andrea Palloni, Francesca Formica, Daria Maria Filippini, Giovanni Brandi, Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna 40138, Italy
Elisa Grassi, Medical Oncology, Ospedale degli Infermi, Faenza 48018, Italy
Stefano Brocchi, Rita Golfieri, Radiology Unit, Department of Diagnostic Medicine and Prevention, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna 40138, Italy
Author contributions: Di Marco M, Carloni R and De Lorenzo S reviewed the literature and contributed to manuscript drafting; Brandi G, Grassi E and Palloni A were attending physicians for the patients and contributed to manuscript drafting; Golfieri R, Formica F and Brocchi S reviewed CT scans and selected the figures; Filippini DM reviewed the literature; Di Marco M was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: The patients provided informed consent for the publication of their cases.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Riccardo Carloni, MD, Doctor, Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna 40138, Italy. riccardo.carloni2@studio.unibo.it
Received: December 19, 2019
Peer-review started: December 19, 2019
First decision: December 28, 2019
Revised: January 8, 2020
Accepted: March 11, 2020
Article in press: March 11, 2020
Published online: April 6, 2020
BACKGROUND
Pancreatic acinar cell carcinoma (PACC) is a rare type of malignant pancreatic cancer that represents approximately 1% of all pancreatic neoplasms. Due to its very low incidence, only a few retrospective studies are available. Although surgery is the first choice for treatment, most patients experience recurrence (mainly in the liver) and there are no clear recommendations for patients with advanced disease.
CASE SUMMARY
We report two patients with PACC treated with surgery who experienced tumour recurrence in the liver. Patient 1 carried a germline mutation in the APC gene. Both patients were treated with gemcitabine plus oxaliplatin and gemcitabine plus capecitabine as first- and second-line therapies, respectively. After a favourable response to chemotherapy, the patients underwent radiofrequency ablation of the remaining liver metastases. For patient 1, we documented a relapse in the liver after a disease-free period of 9 mo, and treatment with gemcitabine plus capecitabine was restarted. The patient achieved a complete response, and he remains alive without evidence of disease recurrence after six years. After radiofrequency ablation, patient 2 experienced disease-free survival for 21 mo, when peritoneal relapse was diagnosed and treated with chemotherapy. The patient achieved a stable disease state for nearly two years; nevertheless, further progressive disease was documented, and he died seven years after the first relapse.
CONCLUSION
PACC presents different biological behaviours than pancreatic adenocarcinoma. Multidisciplinary treatment involving local ablative therapies may be considered for PACC.
Core tip: Pancreatic acinar cell carcinoma (PACC) is a rare type of malignant pancreatic cancer. Surgery represents the first choice for treatment, but most patients experience relapse (mainly located in the liver), and there are no clear recommendations for the treatment of advanced disease. We report two cases of long-term PACC survivors treated with radiofrequency ablation in addition to chemotherapy for liver recurrence after surgery. This case report highlights the different biological behaviour of PACC compared to pancreatic adenocarcinoma and the importance of multidisciplinary treatment involving local ablative therapies, such as radiofrequency ablation, for recurrent PACC.
