RESUMO
Pancreatic mixed neoplasms are very rare. We herein report a unique case of pancreatic mixed acinar-neuroendocrine-ductal carcinoma with trilineage differentiation. The patient was an 83-year-old woman referred to our hospital due to anemia and a pancreatic mass. Contrast-enhanced computed tomography revealed a 60-mm mass in the pancreas. Subtotal stomach-preserving pancreaticoduodenectomy was performed. The postoperative pathological diagnosis was mixed acinar-neuroendocrine-ductal carcinoma. Postoperative chemotherapy was conducted according to the adenocarcinoma and neuroendocrine carcinoma protocols. The patient died 26 months postoperatively. Choosing appropriate chemotherapy for mixed neoplasms is difficult. Cancer gene panel testing, if possible, may support the choice of therapeutic agents.
Assuntos
Carcinoma de Células Acinares , Carcinoma Ductal , Carcinoma Neuroendócrino , Neoplasias Pancreáticas , Feminino , Humanos , Idoso de 80 Anos ou mais , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/genética , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/genética , Carcinoma Neuroendócrino/patologia , Carcinoma de Células Acinares/diagnóstico , Carcinoma de Células Acinares/cirurgia , Neoplasias PancreáticasRESUMO
We encountered an 81-year-old Japanese man with oncocytoma of the parotid gland occurring simultaneously with a Warthin's tumor in the ipsilateral parotid gland. The patient complained of swelling in the right infra-auricular region. Computed tomographic images, magnetic resonance images, and ultrasonography showed two masses in the right parotid gland. Technetium 99m pertechnetate scintigraphy revealed a high accumulation in both tumors. We performed a superficial lobectomy of the parotid gland. Preoperative diagnosis was multiple Warthin's tumor, but upon histopathological examination Warthin's tumor proved to coexist with oncocytoma. In general, the presence of synchronous, major, salivary gland tumors with different histopathology in the ipsilateral parotid gland appears to be unique. This is especially true for the combination of oncocytomas and Warthin's tumors, which is extremely rare. Only eight cases of this kind coincidence were found in our review of the literature. The similarity of oncocytomas and Warthin's tumors based on epidemiology, image diagnostics, and histopathology is discussed.
