Gastroenterologia Japontca Copyright 9 1992 by The Japanese Society of Gastroenterology

I1ol. 27, No. 6 Printed & Japan

Acinar cell carcinoma of the pancreas with elevated serum a-fetoprotein levels: A case report and a review of 28 cases reported in Japan Toshio ITOH 1, Kiyohiko KISHI 1, Masahide TOJO 1, Naoto KITAJIMA 1, Yoshikazu KINOSHITA 1, Tetsuya INATOME 1, Hisashi FUKUZAKI 1, Norimasa NISHIYAMA 2, Hideo TACHIBANA 2, Hiroshi TAKAHASHI 2, Takashi NAKAMURA 2, and Makoto WATANABE 3 *Departments of llnternal Medicine and 2Surgery, Miki City Hospital, MikL Japan; and 3School of Allied Medical Sciences, Kobe University, Kobe, Japan

Summary: A 60-year-old male with elevated serum AFP levels is reported. Other tumor markers apart from AFP were normal. Serum AFP did not bind to Con A or Lentil-lectin by affinity chromatography. Abdominal ultrasonography, computed tomography and endoscopic retrograded cholangiopancreatography demonstrated a tumor extending from the body to the tail of the pancreas. The tumor was strongly suggested to be an acinar cell carcinoma of the pancreas, based on the histological findings of the resected specimen. The peroxidase-antiperoxidase method showed cancer ceils to be positive for AFP. In Japan,' only 27 cases of pancreatic cancer with elevated serum AFP level have been reported. This is the first Japanese case of pancreatic cancer in which the binding of serum AFP to lectins was investigated. GastroenterolJpn 1992;27:785-791. Key words: a-fetoprotein; acinar cell carcinoma of the pancreas; lectin.

Introduction H u m a n alpha-fetoprotein (AFP) was discovered by Bergstrand et al. 1, and also reported by Avelev et al. and Tartarinov et al. 2,3 Since A F P was considered to be specific to patients with hepatocellular carcinoma, it is regarded as a very useful t u m o r marker. Following the recent advances in microanalysis by radioimmunoassay, A F P elevation has been found in patients with n o n - t u m o r o u s liver diseases (e.g., acute or chronic hepatitis and liver cirrhosis) or other gastrointestinal diseases. High blood levels of A F P are seen with particularly high frequency a m o n g cases of gastric cancer with hepatic metastasis. However, pancreatic cancer with elevated s e r u m A F P is rare and only 27 cases have been reported in Japan 4-11 (Table 1). T h e authors recently e n c o u n t e r e d a patient

showing an elevated s e r u m A F P level. In this case, the lectin-binding tests showed the elevated s e r u m A F P to have no relationship with liver disease, and a subsequent detailed examination strongly suggested a diagnosis of acinar cell carcin o m a of the pancreas.

Case Report Elevation of serum A F P was pointed out in a 60year-old male during a routine health check in the a u t u m n of 1988. He visited our hospital in October 1988 to receive a detailed examination. D u r i n g subsequent examinations, abdominal ultrasonography revealed an abnormality in February 1990, for w h i c h he was admitted to our hospital in March 1990. He had no contributory history of disease or family history. On admission, there was

Received February 20, 1992. Accepted June 26, 1992. Address for correspondence: Toshio Itoh, M.D., Department of Internal Medicine, Miki City Hospital, 58-1 Kasa, Miki, Hyogo 673-04, Japan.

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Acinar cell carcinoma of the pancreas with elevated serum alpha-fetoprotein levels: a case report and a review of 28 cases reported in Japan.

A 60-year-old male with elevated serum AFP levels is reported. Other tumor markers apart from AFP were normal. Serum AFP did not bind to Con A or Lent...
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