A rare case of pancreatic mixed acinar-neuroendocrine carcinoma

Pancreatic mixed acinar-neuroendocrine carcinoma (pMANEC) is an extremely rare malignancy with both acinar carcinomas with neuroendocrine lineage differentiations. Herein, we present a case of pMANEC in a 78-year-old male who initially presented to the clinic for night sweats, easy bruising, and lumbar pain, leading to the discovery of a pancreatic mass on imaging. Pathological examinations, including immunohistochemistry, confirmed the diagnosis of possible pMANEC, characterized by acinar and neuroendocrine differentiation. Further diagnostic workup with DOTATATE NM positron emission tomography/computed tomography (PET/CT) scan provided additional insights, confirming the neuroendocrine nature of the tumor. The patient was started on gemcitabine and nab-paclitaxel every other week and also started on lanreotide for treatment. Our case highlights the challenges in diagnosing and managing this rare entity and underscores the need for further research to explore its clinical behavior, molecular characteristics, and optimal therapeutic strategies. Additionally, the potential role of genetic profiling and immunotherapy in improving outcomes for patients with pMANEC warrants investigation.