ArticleEuropean radiology2026
Imaging phenotypes of pancreatic acinar cell carcinoma: a multicenter study of morphologic subtypes and recurrence.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo identify the imaging features of pancreatic acinar cell carcinoma (PACC) and to classify them according to morphological subtypes. MATERIALS AND
methodsThis multicenter retrospective study included 36 patients with pathologically confirmed PACC who underwent CT/MRI from 2008 to 2024. Tumors were classified into three morphologic subtypes based on imaging features identified in this study: Type 1, well-demarcated solid mass; Type 2, predominantly intraductal mass; Type 3, indistinct infiltrative mass. Maximal tumor size, marked diffusion restriction, lobulated internal architecture, venous thrombosis, and proportion of intratumoral necrosis were evaluated. Differences among subtypes were analyzed using the Kruskal-Wallis test and Fisher's exact test. In 28 patients who underwent curative resection, Cox regression analysis was performed to identify predictors of recurrence.
resultsPACC commonly showed marked diffusion restriction (76.7%), lobulated internal architecture (52.8%), and minimal intratumoral necrosis (80.6%). Nineteen tumors were classified as Type 1, eight as Type 2, and nine as Type 3. Type 1 tumors were larger than Type 2 and Type 3 (6.3 cm vs. 3.0 cm vs. 2.5 cm; p = 0.002) and more frequently showed venous thrombosis (31.6% vs. 0% vs. 0%; p = 0.040) and lobulated internal architecture (78.9% vs. 37.5% vs. 11.1%, p = 0.002). On multivariable analysis, maximal tumor size (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.2-2.3) and Type 3 tumor (HR 7.7, 95% CI 1.1-53.6) were independent predictors of recurrence.
conclusionPACC shows characteristic imaging features and distinct morphologic subtypes. Tumor size and the infiltrative subtype may predict postoperative recurrence. KEY POINTS: Question Pancreatic acinar cell carcinoma (PACC) is a rare tumor with imaging features overlapping other pancreatic neoplasms, and imaging biomarkers for recurrence risk remain limited. Findings PACC showed three morphologic imaging phenotypes, and an indistinct infiltrative subtype and larger tumor size were independently associated with recurrence after curative resection. Clinical relevance Recognition of morphologic imaging phenotypes of PACC may help radiologists differentiate PACC from more common pancreatic tumors and identify patients at higher risk of postoperative recurrence.
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