Analysis of misdiagnosis of pancreatic acinar cell carcinoma with significantly elevated alpha-fetoprotein: a case report and literature review.

Acinar cell carcinoma (ACC) is a rare malignant exocrine tumor of the pancreas, often presenting with nonspecific symptoms that lead to diagnostic confusion with other pancreatic neoplasms. This article reports a case of a 72-year-old female ACC patient who was misdiagnosed as Solid pseudopapillary neoplasms (SPN) by an external hospital. Laboratory investigations upon admission revealed a markedly elevated serum alpha-fetoprotein (AFP) level of 2321.18 ng/mL, while contrast-enhanced CT of the upper abdomen demonstrated a mass in the pancreatic head, with the liver showing normal parenchyma and no focal masses or lesions. Following a multidisciplinary team (MDT) discussion, the patient underwent a radical Pancreaticoduodenectomy. The final histopathological diagnosis confirmed ACC. This case underscores that in patients with pancreatic masses exhibiting misleading imaging features suggestive of SPN, a significantly elevated serum AFP level should serve as a critical diagnostic clue prompting consideration of ACC. Integrating tumor marker analysis, imaging findings, and MDT evaluation is essential to minimize preoperative misdiagnosis of such rare entities.