Preoperative transcatheter arterial embolization enables safe resection of a giant hypervascular pancreatic acinar cell carcinoma: A case report

Pancreatic acinar cell carcinoma (ACC) is a rare malignant neoplasm that accounts for 0.4%-0.7% of all pancreatic tumors. It often presents as a large, bulky mass owing to its expansive growth pattern. We report a case of a large pancreatic ACC that achieved remarkable long-term recurrence-free survival after successful surgical resection supported by preoperative interventional radiology (IR). A 64-year-old male presented to our hospital with weight loss and abdominal distension. A firm mass was palpable in the left upper abdomen. CT revealed a giant, heterogeneously enhancing tumor measuring 16.8 cm. Because of the anticipated massive intraoperative hemorrhage associated with tumor size and hypervascularity, Transcatheter Arterial Embolization (TAE) was performed preoperatively. The bilateral inferior diaphragmatic artery, posterior gastric, and splenic arterial branches supplying the tumor were embolized using metal coils and embolic materials. A safe radical resection was successfully performed (distal pancreatectomy, splenectomy, partial gastrectomy, partial colon resection, and left adrenalectomy). The pathological diagnosis confirmed pancreatic ACC (stage IIB). The patient has maintained recurrence-free survival for more than 5 years postoperatively. This case highlights that aggressive surgical resection achieves long-term survival in large pancreatic ACCs. Preoperative IR-TAE effectively controlled bleeding risk, underscoring the crucial role of this technique in safely managing high-risk, large, hypervascular pancreatic tumors. Physicians must consider ACC as a differential diagnosis for large pancreatic masses that may mimic other cystic solid lesions, such as Intraductal Papillary Mucinous Neoplasm (IPMN). Close multidisciplinary collaboration, particularly between interventional radiology and surgery, is essential in managing these challenging cases.