Misunderstood Gastric Perforation of a Pancreatic Acinar Cell Carcinoma: A Wolf in Sheep’s Clothing

A 70-year-old man was admitted to the Emergency Department (ED) for marked asthenia and severe anemia. In addition, a high level of lipase found. During hospitalization, locally advanced gastric cancer diagnosed, with endoscopic evidence large polyploid formation originating under cardias that occupied most lumen. total body CT scan performed before surgery; tumor affected posterior wall, tenacious infiltration pancreatic body. Therefore, we gastrectomy esophageal jejunum anastomosis reconstruction intestinal continuity according Roux, distal spleno-pancreatectomy, cholecystectomy. At histology, acinar cell carcinoma (PACC) full thickness wall diagnosed. Acinar carcinomas are highly aggressive neoplasms, surgical resection, when feasible, is treatment choice regardless size, also because role neoadjuvant or adjuvant chemo- radiotherapy remains uncodified.