{"id":21614,"date":"2026-07-07T07:00:00","date_gmt":"2026-07-07T07:00:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=21614"},"modified":"2026-07-05T16:09:14","modified_gmt":"2026-07-05T16:09:14","slug":"transformacao-cistica-acinar-diagnostico-diferencial-ipmn","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/transformacao-cistica-acinar-diagnostico-diferencial-ipmn\/","title":{"rendered":"Transforma\u00e7\u00e3o C\u00edstica Acinar simulando IPMN de ductos secund\u00e1rios: relato de caso e revis\u00e3o da literatura"},"content":{"rendered":"\n<h2 id=\"h-introducao\" class=\"wp-block-heading\"><br><strong>Introdu\u00e7\u00e3o<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">As les\u00f5es c\u00edsticas pancre\u00e1ticas representam um desafio diagn\u00f3stico crescente na pr\u00e1tica cl\u00ednica. Embora neoplasia papil\u00edfera mucinosa intraductal (IPMN), neoplasias mucinosas c\u00edsticas (MCN) e cistoadenomas serosos representem a maioria dos casos, entidades raras podem mimetizar essas les\u00f5es e gerar importantes dilemas diagn\u00f3sticos.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><br>A <strong>Transforma\u00e7\u00e3o C\u00edstica Acinar (Acinar Cystic Transformation \u2013 ACT)<\/strong> \u00e9 uma condi\u00e7\u00e3o benigna e extremamente rara, frequentemente confundida com neoplasias mucinosas pancre\u00e1ticas devido ao aspecto multic\u00edstico e ao padr\u00e3o em \u201ccacho de uva\u201d. Relatamos a seguir um caso de les\u00e3o c\u00edstica pancre\u00e1tica multifocal, inicialmente interpretada como IPMN de ductos secund\u00e1rios, mas que apresentava caracter\u00edsticas incomuns e levantou a hip\u00f3tese diagn\u00f3stica de Transforma\u00e7\u00e3o C\u00edstica Acinar.<\/p>\n\n\n\n<h2 id=\"h-relato-do-caso\" class=\"wp-block-heading\"><br><strong>Relato do Caso<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Paciente do sexo feminino, 54 anos, assintom\u00e1tica e sem hist\u00f3rico de pancreatite, apresentou achado incidental de m\u00faltiplas les\u00f5es c\u00edsticas pancre\u00e1ticas.<\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?attachment_id=21616\"><img fetchpriority=\"high\" decoding=\"async\" width=\"453\" height=\"330\" data-id=\"21616\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Ressonancia-magnetica-1.jpg\" alt=\"\" class=\"wp-image-21616\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Ressonancia-magnetica-1.jpg?v=1782833442 453w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Ressonancia-magnetica-1-300x219.jpg?v=1782833442 300w\" sizes=\"(max-width: 453px) 100vw, 453px\" \/><\/a><figcaption class=\"wp-element-caption\">Resson\u00e2ncia Magn\u00e9tica de abdome evidenciando cistos pancre\u00e1ticos com hipersinal em T2 (Figura 1)<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?attachment_id=21615\"><img decoding=\"async\" width=\"412\" height=\"331\" data-id=\"21615\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Ressonancia-magnetica-2.jpg\" alt=\"\" class=\"wp-image-21615\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Ressonancia-magnetica-2.jpg?v=1782833439 412w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Ressonancia-magnetica-2-300x241.jpg?v=1782833439 300w\" sizes=\"(max-width: 412px) 100vw, 412px\" \/><\/a><figcaption class=\"wp-element-caption\"><br>Resson\u00e2ncia Magn\u00e9tica de abdome evidenciando cistos pancre\u00e1ticos com hipersinal em T2 (Figura 2)<\/figcaption><\/figure>\n<\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">A ecoendoscopia (EUS) evidenciou:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>M\u00faltiplos cistos distribu\u00eddos pela cabe\u00e7a, corpo e cauda pancre\u00e1tica.<\/li>\n\n\n\n<li>Maior les\u00e3o localizada na cauda, medindo 2,6 cm, com paredes regulares e aus\u00eancia de n\u00f3dulos murais.<\/li>\n\n\n\n<li>Les\u00e3o adicional na cauda, medindo 2,0 cm, contendo imagem nodular de 4 mm com halo hiperecoico e centro hipoecoico, sugestiva de rolha de mucina ou plug proteico.<\/li>\n\n\n\n<li>Alguns cistos apresentavam padr\u00e3o em \u201ccacho de uva\u201d e duvidosa comunica\u00e7\u00e3o com o ducto pancre\u00e1tico principal (DPP); a maioria n\u00e3o apresentava comunica\u00e7\u00e3o com DPP, e parte dos cistos tinha localiza\u00e7\u00e3o predominantemente perif\u00e9rica no par\u00eanquima pancre\u00e1tico<\/li>\n\n\n\n<li>Ducto pancre\u00e1tico principal sem dilata\u00e7\u00e3o.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-2 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?attachment_id=21619\"><img decoding=\"async\" width=\"377\" height=\"255\" data-id=\"21619\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Figura-3-Cistos-com-padrao-em-cacho-de-uva-e1783267326491.jpg\" alt=\"\" class=\"wp-image-21619\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Figura-3-Cistos-com-padrao-em-cacho-de-uva-e1783267326491.jpg?v=1782834563 377w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Figura-3-Cistos-com-padrao-em-cacho-de-uva-e1783267326491-300x203.jpg?v=1782834563 300w\" sizes=\"(max-width: 377px) 100vw, 377px\" \/><\/a><figcaption class=\"wp-element-caption\"><br>Cistos com padr\u00e3o em \u201dcacho de uva\u201d<br>(Figura 3)<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?attachment_id=21618\"><img loading=\"lazy\" decoding=\"async\" width=\"399\" height=\"252\" data-id=\"21618\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Figura-4-lesao-cistica-do-pancreas-e1783267477945.jpg\" alt=\"\" class=\"wp-image-21618\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Figura-4-lesao-cistica-do-pancreas-e1783267477945.jpg?v=1782834561 399w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Figura-4-lesao-cistica-do-pancreas-e1783267477945-300x189.jpg?v=1782834561 300w\" sizes=\"(max-width: 399px) 100vw, 399px\" \/><\/a><figcaption class=\"wp-element-caption\">Les\u00e3o c\u00edstica medindo 2,6 cm na cauda do p\u00e2ncreas (Figura 4)<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?attachment_id=21617\"><img loading=\"lazy\" decoding=\"async\" width=\"437\" height=\"253\" data-id=\"21617\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Figura-5-Lesao-com-imagem-nodular-e1783267520516.jpg\" alt=\"\" class=\"wp-image-21617\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Figura-5-Lesao-com-imagem-nodular-e1783267520516.jpg?v=1782834558 437w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2026\/06\/Figura-5-Lesao-com-imagem-nodular-e1783267520516-300x174.jpg?v=1782834558 300w\" sizes=\"(max-width: 437px) 100vw, 437px\" \/><\/a><figcaption class=\"wp-element-caption\">Les\u00e3o de 2,0 cm com imagem nodular de 4 mm (halo hiperecoico e centro hipoecoico), sugestiva de rolha de mucina ou plug proteico (Figura 5) <\/figcaption><\/figure>\n<\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">A pun\u00e7\u00e3o aspirativa com agulha 22G do maior cisto obteve 11 mL de l\u00edquido amarelo citrino, de aspecto fluido, com teste de fil\u00e2ncia <strong>negativo<\/strong>. A an\u00e1lise bioqu\u00edmica demonstrou:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Amilase: <\/strong>168 U\/L<\/li>\n\n\n\n<li><strong>CEA: <\/strong>48 ng\/mL<\/li>\n\n\n\n<li><strong>Glicose: <\/strong>&lt; 10 mg\/dL<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Este caso cl\u00ednico apresenta, portanto, um importante dilema diagn\u00f3stico:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>a distribui\u00e7\u00e3o multifocal dos cistos e o aspecto em &#8220;cacho de uva&#8221; sugeriam <strong>IPMN<\/strong> de ductos secund\u00e1rios (IPMN-BD).<\/li>\n\n\n\n<li>No entando, a comunica\u00e7\u00e3o com o DPP n\u00e3o ficou clara, e alguns cistos eram perif\u00e9ricos no par\u00eanquima.<\/li>\n\n\n\n<li>Glicose baixa (&lt; 10 mg\/dL) tamb\u00e9m falava a favor de IPMN, por\u00e9m a amilase baixa (168 U\/L) falava contra esse diagn\u00f3stico (embora amilase baixa tamb\u00e9m possa ocorrer em alguns casos de IPMN-BD)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Nesse contexto, a <strong>Transforma\u00e7\u00e3o C\u00edstica Acinar <\/strong>surge como um diagn\u00f3stico diferencial.<\/p>\n\n\n\n<h2 id=\"h-o-que-e-a-transformacao-cistica-acinar\" class=\"wp-block-heading\"><br><strong>O que \u00e9 a Transforma\u00e7\u00e3o C\u00edstica Acinar?<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A ACT \u00e9 uma les\u00e3o c\u00edstica pancre\u00e1tica extremamente rara e benigna. Anteriormente denominada cistoadenoma acinar ou degenera\u00e7\u00e3o c\u00edstica acinar, atualmente acredita-se que represente uma transforma\u00e7\u00e3o metapl\u00e1sica ou malformativa das estruturas acinares do p\u00e2ncreas, e n\u00e3o uma neoplasia verdadeira.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Seu reconhecimento \u00e9 importante porque a ACT pode simular outras les\u00f5es c\u00edsticas pancre\u00e1ticas potencialmente malignas, como o IPMN e a MCN, levando frequentemente a d\u00favidas diagn\u00f3sticas e, em alguns casos, \u00e0 indica\u00e7\u00e3o cir\u00fargica.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A ACT caracteriza-se pela dilata\u00e7\u00e3o e transforma\u00e7\u00e3o c\u00edstica de estruturas acinares pancre\u00e1ticas. Diferentemente das MCN, seus cistos s\u00e3o revestidos por epit\u00e9lio com diferencia\u00e7\u00e3o acinar, produtor de enzimas digestivas, e n\u00e3o por c\u00e9lulas produtoras de mucina.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">At\u00e9 o momento, n\u00e3o existe evid\u00eancia convincente de potencial maligno associado \u00e0 ACT; por isso, considera-se uma les\u00e3o benigna.<\/p>\n\n\n\n<h2 id=\"h-epidemiologia\" class=\"wp-block-heading\"><br><strong>Epidemiologia<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A ACT \u00e9 uma entidade rara, com pouco mais de uma centena de casos descritos na literatura mundial. Ocorre predominantemente em mulheres, que representam cerca de dois ter\u00e7os dos casos relatados, e costuma ser diagnosticada entre a quarta e a sexta d\u00e9cadas de vida.<\/p>\n\n\n\n<h2 id=\"h-quadro-clinico\" class=\"wp-block-heading\"><br><strong>Quadro cl\u00ednico<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Na maioria dos pacientes, a ACT \u00e9 um achado incidental durante exames realizados por outros motivos.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Quando presentes, os sintomas s\u00e3o geralmente inespec\u00edficos e podem incluir: Dor ou desconforto abdominal, n\u00e1useas e sensa\u00e7\u00e3o de plenitude p\u00f3s-prandial. Sintomas obstrutivos ou pancreatite, por sua vez,  s\u00e3o incomuns.<\/p>\n\n\n\n<h2 id=\"h-achados-de-imagem\" class=\"wp-block-heading\"><br><strong>Achados de imagem<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A tomografia computadorizada, a resson\u00e2ncia magn\u00e9tica e a ecoendoscopia costumam demonstrar les\u00f5es multic\u00edsticas compostas por numerosos pequenos cistos agrupados.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">O aspecto em \u201ccacho de uva\u201d \u00e9 uma das caracter\u00edsticas mais frequentemente descritas. Embora esse padr\u00e3o seja classicamente associado ao IPMN de ductos secund\u00e1rios, na ACT ele decorre da dilata\u00e7\u00e3o de m\u00faltiplos \u00e1cinos e ductos terminais.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Assim, as principais caracter\u00edsticas de imagem incluem:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Les\u00f5es multic\u00edsticas formadas por m\u00faltiplos pequenos cistos<\/li>\n\n\n\n<li>Aspecto em \u201ccacho de uva\u201d<\/li>\n\n\n\n<li>Distribui\u00e7\u00e3o segmentar ou difusa no p\u00e2ncreas, frequentemente com cistos perif\u00e9ricos<\/li>\n\n\n\n<li>Aus\u00eancia habitual de comunica\u00e7\u00e3o com o ducto pancre\u00e1tico principal<\/li>\n\n\n\n<li>Poss\u00edvel acometimento de extensas \u00e1reas do \u00f3rg\u00e3o<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Ainda assim, a diferencia\u00e7\u00e3o com IPMN, MCN e cistoadenoma seroso pode ser dif\u00edcil apenas com exames de imagem.<\/p>\n\n\n\n<h2 id=\"h-o-que-a-ecoendoscopia-pode-mostrar\" class=\"wp-block-heading\"><br><strong>O que a ecoendoscopia pode mostrar?<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Frequentemente, utiliza-se a ecoendoscopia na investiga\u00e7\u00e3o diagn\u00f3stica.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ao exame, a les\u00e3o geralmente se apresenta como um agrupamento de m\u00faltiplos pequenos cistos, sem n\u00f3dulos murais evidentes e sem caracter\u00edsticas francamente suspeitas para malignidade. Os cistos costumam parecer \u201cpendurados\u201d no par\u00eanquima perif\u00e9rico, sem uma conex\u00e3o evidente com o sistema ductal principal.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Entretanto, os achados ecoendosc\u00f3picos isoladamente raramente permitem um diagn\u00f3stico definitivo.<\/p>\n\n\n\n<h2 id=\"h-analise-do-liquido-cistico\" class=\"wp-block-heading\"><br><strong>An\u00e1lise do l\u00edquido c\u00edstico<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A pun\u00e7\u00e3o aspirativa guiada por ecoendoscopia (EUS-FNA) pode fornecer informa\u00e7\u00f5es complementares, embora os resultados sejam frequentemente inespec\u00edficos.<\/p>\n\n\n\n<h3 id=\"h-cea\" class=\"wp-block-heading\"><br><strong>CEA<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Os n\u00edveis costumam ser baixos, refletindo a natureza n\u00e3o mucinosa da les\u00e3o.<\/li>\n\n\n\n<li>Entretanto, casos com eleva\u00e7\u00e3o do CEA j\u00e1 foram descritos, o que pode levar \u00e0 suspeita equivocada de IPMN ou MCN.<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-amilase\" class=\"wp-block-heading\"><br><strong>Amilase<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>N\u00edveis de amilase s\u00e3o bastante vari\u00e1veis.<\/li>\n\n\n\n<li>Podem estar baixos quando n\u00e3o existe comunica\u00e7\u00e3o com o sistema ductal pancre\u00e1tico ou apresentar eleva\u00e7\u00e3o em alguns pacientes &#8211; dificultando, assim, a diferencia\u00e7\u00e3o com pseudocistos e IPMNs.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Por esse motivo, a an\u00e1lise bioqu\u00edmica do l\u00edquido c\u00edstico raramente \u00e9 suficiente para estabelecer o diagn\u00f3stico.<\/p>\n\n\n\n<h3 id=\"h-citologia-e-diagnostico-histologico\" class=\"wp-block-heading\"><br><strong>Citologia e diagn\u00f3stico histol\u00f3gico<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A citologia obtida por pun\u00e7\u00e3o frequentemente apresenta baixa celularidade e resultados inconclusivos.<\/li>\n\n\n\n<li>Quando material representativo \u00e9 obtido, podem ser identificadas c\u00e9lulas acinares contendo gr\u00e2nulos de zimog\u00eanio.<\/li>\n\n\n\n<li>O diagn\u00f3stico definitivo depende da demonstra\u00e7\u00e3o de diferencia\u00e7\u00e3o acinar por meio da anatomia patol\u00f3gica e da imunohistoqu\u00edmica.<\/li>\n\n\n\n<li>Os principais marcadores utilizados s\u00e3o:\n<ul class=\"wp-block-list\">\n<li>Tripsina<\/li>\n\n\n\n<li>Quimotripsina<\/li>\n\n\n\n<li>BCL10<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A positividade para esses marcadores, portanto, \u00e9 considerada a principal evid\u00eancia de diferencia\u00e7\u00e3o acinar.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Mais recentemente, a bi\u00f3psia atrav\u00e9s da agulha guiada por ecoendoscopia (through-the-needle biopsy \u2013 TTNB) tem aumentado a capacidade diagn\u00f3stica pr\u00e9-operat\u00f3ria em casos selecionados.<\/p>\n\n\n\n<h3 id=\"h-prognostico\" class=\"wp-block-heading\"><br><strong>Progn\u00f3stico<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">O progn\u00f3stico da ACT \u00e9 excelente.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">At\u00e9 o momento, n\u00e3o h\u00e1 evid\u00eancias consistentes de transforma\u00e7\u00e3o maligna ou progress\u00e3o para c\u00e2ncer pancre\u00e1tico. Diferentemente do IPMN, que pode evoluir para adenocarcinoma ductal pancre\u00e1tico, a ACT \u00e9 considerada uma les\u00e3o benigna sem potencial maligno comprovado.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Por esse motivo, quando o diagn\u00f3stico \u00e9 estabelecido com seguran\u00e7a, uma estrat\u00e9gia conservadora com acompanhamento cl\u00ednico e radiol\u00f3gico pode ser apropriada.<\/p>\n\n\n\n<h2 id=\"h-voltando-ao-nosso-caso-clinico\" class=\"wp-block-heading\"><br><strong>Voltando ao nosso caso cl\u00ednico<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A distribui\u00e7\u00e3o multifocal dos cistos, o padr\u00e3o em \u201ccacho de uva\u201d, a poss\u00edvel comunica\u00e7\u00e3o ductal e a glicose extremamente reduzida (&lt;10 mg\/dL) sugeriam, inicialmente, o diagn\u00f3stico de IPMN-BD. Contudo, alguns achados do caso levantaram importante d\u00favida diagn\u00f3stica: negatividade no teste de fil\u00e2ncia, aspecto aquoso do l\u00edquido aspirado, localiza\u00e7\u00e3o perif\u00e9rica dos cistos, amilase baixa. A imagem inicialmente interpretada como poss\u00edvel \u201crolha de mucina\u201d pode representar plugues proteicos intrac\u00edsticos, achado previamente descrito em casos de ACT.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Embora n\u00e3o seja poss\u00edvel estabelecer diagn\u00f3stico definitivo sem confirma\u00e7\u00e3o histol\u00f3gica, os achados morfol\u00f3gicos tornam a ACT uma hip\u00f3tese plaus\u00edvel, especialmente pela multifocalidade difusa, pela distribui\u00e7\u00e3o perif\u00e9rica dos cistos e pela aus\u00eancia clara de comunica\u00e7\u00e3o ductal.<\/p>\n\n\n\n<h2 id=\"h-conclusao\" class=\"wp-block-heading\"><br><strong>Conclus\u00e3o<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Embora rara, a ACT deve ser considerada no diagn\u00f3stico diferencial de pacientes com m\u00faltiplos cistos pancre\u00e1ticos, especialmente quando h\u00e1 distribui\u00e7\u00e3o perif\u00e9rica, aus\u00eancia de comunica\u00e7\u00e3o ductal evidente e resultados bioqu\u00edmicos conflitantes. Este caso ilustra, portanto, as limita\u00e7\u00f5es da interpreta\u00e7\u00e3o isolada dos marcadores do l\u00edquido c\u00edstico e refor\u00e7a o valor da an\u00e1lise morfol\u00f3gica detalhada na investiga\u00e7\u00e3o das les\u00f5es c\u00edsticas pancre\u00e1ticas.<\/p>\n\n\n\n<h2 id=\"h-pontos-chave\" class=\"wp-block-heading\"><br><strong>Pontos-chave<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list has-pale-ocean-gradient-background has-background\">\n<li>A ACT \u00e9 uma rara les\u00e3o c\u00edstica benigna do p\u00e2ncreas.<\/li>\n\n\n\n<li>Antigamente era chamada de cistoadenoma acinar ou degenera\u00e7\u00e3o c\u00edstica acinar.<\/li>\n\n\n\n<li>\u00c9 formada por estruturas revestidas por epit\u00e9lio com diferencia\u00e7\u00e3o acinar.<\/li>\n\n\n\n<li>Frequentemente apresenta aspecto multic\u00edstico em \u201ccacho de uva\u201d.<\/li>\n\n\n\n<li>Geralmente n\u00e3o se comunica com o ducto pancre\u00e1tico principal.<\/li>\n\n\n\n<li>Os n\u00edveis de CEA e amilase do l\u00edquido c\u00edstico s\u00e3o vari\u00e1veis e pouco espec\u00edficos.<\/li>\n\n\n\n<li>O diagn\u00f3stico definitivo depende da histologia e da imuno-histoqu\u00edmica.<\/li>\n\n\n\n<li>N\u00e3o existe potencial maligno comprovado.<\/li>\n\n\n\n<li>Deve ser lembrada no diagn\u00f3stico diferencial das demais les\u00f5es c\u00edsticas pancre\u00e1ticas.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Para mais casos ilustrando o desafio diagn\u00f3stico da ACT, acesse <a href=\"https:\/\/journals.lww.com\/acgcr\/fulltext\/2024\/02000\/acinar_cystic_transformation_of_the_pancreas_with.22.aspx\">este artigo publicado no ACG Case Reports Journal<\/a>.<\/p>\n\n\n\n<h2 id=\"h-referencias\" class=\"wp-block-heading\"><br><strong>Refer\u00eancias:<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Acinar Cell Cystadenoma of the Pancreas: A Benign Neoplasm or Non-Neoplastic Ballooning of Acinar and Ductal Epithelium?. The American Journal of Surgical Pathology. 2013. Singhi AD, Norwood S, Liu TC, et al.<\/li>\n\n\n\n<li>Acinar Cystic Transformation of the Pancreas: Histomorphology and Molecular Analysis to Unravel Its Heterogeneous Nature. The American Journal of Surgical Pathology. 2023. Luchini C, Mattiolo P, Basturk O, et al.<\/li>\n\n\n\n<li>Comprehensive Characterisation of Acinar Cystic Transformation of the Pancreas: A Systematic Review. Journal of Clinical Pathology. 2023. Mattiolo P, Wang H, Basturk O, et al.<\/li>\n\n\n\n<li>Pancreatic Cysts. The New England Journal of Medicine. 2024. Gonda TA, Cahen DL, Farrell JJ.<\/li>\n\n\n\n<li>Cystic Lesions of the Pancreas: Differential Diagnosis and Cytologic-Histologic Correlation. Archives of Pathology &amp; Laboratory Medicine. 2020. Abdelkader A, Hunt B, Hartley CP, Panarelli NC, Giorgadze T.<\/li>\n<\/ol>\n\n\n\n<h2 id=\"h-como-citar-este-artigo\" class=\"wp-block-heading\"><strong>Como citar este artigo<\/strong><\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background wp-block-paragraph\">Oissa GM, Namur G, Martins BC. Transforma\u00e7\u00e3o C\u00edstica Acinar simulando IPMN de ductos secund\u00e1rios: relato de caso e revis\u00e3o da literatura. Endoscopia Terapeutica 2026 Vol II. Dispon\u00edvel em: <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/?p=21614\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/transformacao-cistica-acinar-simulando-ipmn-de-ductos-secundarios-relato-de-caso-e-revisao-da-literatura\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introdu\u00e7\u00e3o As les\u00f5es c\u00edsticas pancre\u00e1ticas representam um desafio diagn\u00f3stico crescente na pr\u00e1tica cl\u00ednica. Embora&hellip;<\/p>\n","protected":false},"author":5981,"featured_media":21615,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[489,488,356,409,500],"ano":[847],"tipo":[154],"volume":[147],"class_list":["post-21614","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","tag-cisto-pancreatico","tag-cistoadenoma-mucinoso","tag-ecoendoscopia","tag-eus","tag-ipmn","ano-847","tipo-ecoendoscopia","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Transforma\u00e7\u00e3o C\u00edstica Acinar: Diagn\u00f3stico Diferencial do IPMN<\/title>\n<meta name=\"description\" content=\"Transforma\u00e7\u00e3o c\u00edstica acinar simulando IPMN: confira um caso cl\u00ednico, achados de imagem e crit\u00e9rios de diagn\u00f3stico diferencial na EUS-FNA.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/transformacao-cistica-acinar-diagnostico-diferencial-ipmn\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Transforma\u00e7\u00e3o C\u00edstica Acinar simulando IPMN de ductos secund\u00e1rios: relato de caso e revis\u00e3o da literatura\" \/>\n<meta property=\"og:description\" content=\"Introdu\u00e7\u00e3o As les\u00f5es c\u00edsticas pancre\u00e1ticas representam um desafio diagn\u00f3stico crescente na pr\u00e1tica cl\u00ednica. 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