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23.06.2015 . . . . . . . . . category:Water quality category:Surface waters of Canada category:Water bodies of Canada category:Environmental protection in Canada category:Rivers of Canada category:Lakes of Quebec category:Rivers of Quebec Category:Water pollution in CanadaINTRODUCTION {#sec1-1} ============ Pancreatic acinar cell carcinoma (PACC) is a rare histological variant of pancreatic cancer that can only be differentiated from pancreatic adenocarcinoma (PAC) by immunohistochemistry. PAC are often difficult to differentiate from pancreatic acinar cell carcinoma (PACC) with either characteristic radiological findings or hematological and biochemical tests. It may be differentiated from PAC by immunohistochemistry using pancreatic markers such as CEA, keratin, and glucagon. A case of PAC has been reported in literature that displayed duodenal stricture. To the best of our knowledge, no case of PAC has been reported in association with duodenal stricture. We report the case of a patient with pancreatic ductal adenocarcinoma who was misdiagnosed as PAC with duodenal stricture and successfully treated with duodenal stenting and intraoperative brushing. CASE REPORT {#sec1-2} =========== A 52-year-old male was brought to our hospital with complaints of abdominal pain and jaundice. He had weight loss and anorexia for the past one month. He had a history of choledocholithiasis which was treated by a percutaneous transhepatic cholangiography and ERCP one month before presentation. The patient was apparently well with normal vital signs except for jaundice. Abdominal examination revealed a soft abdomen with normal bowel sounds and a palpable mass at the epigastric region. His past medical history was unremarkable, and he had no allergies. Laboratory investigations showed a white blood cell count of 14.3 × 10^3^ cells/mm^3^ and a platelet count of 237 × 10^3^ cells/mm^3^. Serum bilirubin was elevated to 14.2 mg/dL. Abdominal ultrasound showed thickening of the common bile duct and gall bladder wall suggestive of a choled

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