PMC10351044_01
Histopathologic examinations of primary tumor. (A) Low magnification field of view. (B) High magnification field of view. A dense, nested or lamellar arrangement of tumor cells can be observed, some of which are in the form of vesicles or small glandular lumen structures. (C) Immunohistochemistry reaction. The results showed PCK (+), EMA (partial +), CK19 (partial +), CK7 (scattered +) Syn (scattered little +) and CgA (scattered little +).
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The pathology diagnosis was pancreatic acinar cell carcinoma (PACC) (stage IV) ( Figure 1 ).
Results for PET-CT examination after chemotherapy and targeted therapy (March 10th, 2021).
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PET/CT scan showed increased number of tumors at the primary site and detected a new pelvic metastase ( Figure 2 ).
Histopathologic and immunohistochemical examinations of biopsy tissue from the pelvic metastase.
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Immunohistochemical results were Ki-67 (+20%), CD10 (-), CD56 (-), CgA (-), P53(+), PCK (+), SYN (+), CK7(+), CK20(-), COX-2(+), Villin (+), CDX-2(+), P40(-), Pax-8(-), SSTR2(+), and PD-1 (-) ( Figure 3 ).
CT examination results. March 2nd was during anlotinib treatment. April 28th was before radiotherapy. June 22nd was after immunotherapy plus radiotherapy, and December 16th was during maintenance immunotherapy.
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However, in August 2022, CT examination indicated disease progression with multiple metastases to the liver and bone.  Figure 4  showed the image changes of the same lesion site before and after treatment.  Figure 5  showed the treatment flow chart.
Flow chart of the treatment timeline.
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However, in August 2022, CT examination indicated disease progression with multiple metastases to the liver and bone.  Figure 4  showed the image changes of the same lesion site before and after treatment.  Figure 5  showed the treatment flow chart.