LONG-TERM FOLLOW-UP OF A HEPATIC METASTATIC ACINUS CELL-CARCINOMA OF THE PANCREAS USING FDG-PET

A 33 years old woman presented with cramp-like abdominal pain. Ultra-s ound examination revealed multiple lesions in the liver of hyper- and hypoechoic echogenicity which in accordance to subsequently peri forme d computed tomography and dynamic hepatobiliary scintigraphy were cons idered to be a focal nodular hyperplasia (FNH). A severe increase of t he serum lipase concentration. suspected to be an acute pancreatitis, was treated conservatively and led to a short: improvement of symptoms . Some months later, a severe progression of the pain symptoms occurre d, along with a measurable expansion of the abdominal circumference an d palpable tumors oi the liver. The dynamic hepatobiliary imaging and the static liver scan showed a decreased perfusion and function of the nodes as well as a reduced RES activity, respectively. A subsequently performed Positron Emission Tomography (PET) with F-18-Fluorodeoxyglu cose (FDG) showed a massively increased glucose metabolism of the live r tumors. The histologic result of several biopsies of the tumors reve aled metastases of an acinus cell carcinoma of the pancreas. Under sys temic and local chemotherapy, a temporary remission could be obtained that was clearly detectable in a second FDG-PET. Nevertheless, during the further course of the disease, a progression occurred being detect able in an additional control PET-study by an increase in tumor size a s well as in tumor glucose metabolism The patient died in liver coma 1 5 months after the histologic diagnosis was obtained.