© 2015 Wolters Kluwer Health, Inc. All rights reserved. Acinar carcinoma is extremely rare. In this report, we present the clinical and pathologic features of three cases that we have encountered in a busy EUS-FNA service. All 3 cases were diagnosed on final histology using immunostains and electron microscopy. Our cases demonstrated the rarity of this neoplasm and the need for ancillary testing for accurate diagnosis.