Computed tomography features of acinar cell carcinoma of the pancreas - 05/03/20

Doi : 10.1016/j.diii.2020.02.007

M. Barat ^a,^b,⁎ , A. Dohan ^a,^b, S. Gaujoux ^b,^c, C. Hoeffel ^d, D. Jornet ^a, A. Oudjit ^a, R. Coriat ^b,^e, M. Barret ^b,^e, B. Terris ^b,^f, P. Soyer ^a,^b
^a Department of Radiology, Hôpital Cochin, AP–HP, 75014 Paris, France
^b Université de Paris, Descartes-Paris 5, 75006 Paris, France
^c Department of Abdominal Surgery, Hôpital Cochin, AP–HP, 75014 Paris, France
^d Department of Radiology, Hôpital Robert Debré, 51092 Reims, France
^e Department of Gastroenterology, Hôpital Cochin, AP–HP, 75014 Paris, France
^f Department of Pathology, Hôpital Cochin, AP–HP, 75014 Paris, France

^⁎Corresponding author. Department of Radiology, Hôpital Cochin, AP–HP, 27, Rue du Faubourg Saint-Jacques, 75014 Paris, France.Department of Radiology, Hôpital Cochin, AP–HP27, Rue du Faubourg Saint-JacquesParis75014France

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Highlights

•	Absence of bile duct dilatation is the most discriminating variable for the diagnosis of pancreatic acinar cell carcinoma.
•	Hepatic metastases, visible lymph nodes and involvement of adjacent organ are discriminating and independently associated variables for the diagnosis of pancreatic acinar cell carcinoma.
•	CT helps diagnose pancreatic acinar cell carcinoma in the presence of several categorical findings, which are more frequently observed in pancreatic acinar cell carcinoma than in pancreatic ductal adenocarcinoma.

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Abstract

Purpose

To report the computed tomography (CT) features of pancreatic acinar cell carcinoma (ACC) and identify CT features that may help discriminate between pancreatic ACC and pancreatic ductal adenocarcinoma (PDA).

Materials and methods

The CT examinations of 20 patients (13 men, 7 women; mean age, 66.5±10.7 [SD] years; range: 51–88 years) with 20 histopathologically proven pancreatic ACC were reviewed. CT images were analyzed qualitatively and quantitatively and compared to those obtained in 20 patients with PDA. Comparisons were performed using univariate analysis with a conditional logistic regression model.

Results

Pancreatic ACC presented as an enhancing (20/20; 100%), oval (15/20; 75%), well-delineated (14/20; 70%) and purely solid (13/20; 65%) pancreatic mass with a mean diameter of 52.6±28.0 (SD) mm (range: 24–120mm) in association with visible lymph nodes (14/20; 70%). At univariate analysis, well-defined margins (Odds ratio [OR], 7.00; P=0.005), nondilated bile ducts (OR, 9.00; P=0.007), visible lymph nodes (OR, 4.33; P=0.028) and adjacent organ involvement (OR, 5.67; P=0.02) were the most discriminating CT features to differentiate pancreatic ACC from PDA. When present, lymph nodes were larger in patients with pancreatic ACC (14±4.8 [SD]; range: 7–25mm) than in those with PDA (8.8±4.1 [SD]; range: 5–15mm) (P=0.039).

Conclusion

On CT, pancreatic ACC presents as an enhancing, predominantly oval and purely solid pancreatic mass that most frequently present with no bile duct dilatation, no visible lymph nodes, no adjacent organ involvement and larger visible lymph nodes compared to PDA.

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Keywords : Tomography, X-ray computed, Carcinoma, Acinar cell, Pancreatic neoplasms

Abbreviations : ACC, CI, CT, MRI, OR, PDA, SD