A 63-year-old woman was referred to emergency department with sudden epigastria pain reporting that pain had started 1 month ago. Abdominal ultrasound (US) revealed a mass in pancreas. On CT scans, a lesion of 30 mm in the pancreatic neck was found. PET-CT showed an increased uptake in the head of the pancreas (SUV: 7.45) (). Eco-endoscopy identified a solid mass uT3N1, and the biopsy results were compatible with adenocarcinoma. From the family history, mother of the patient had endometrial cancer, sister suffered from breast cancer, and aunt also had breast cancer, all of them were BRCA-positive. The patient underwent the BRCA test, and the BRCA2 mutation was identified. Neoadjuvant chemotherapy with FOLFIRINOX was started with excellent tolerance after 6 cycles and subsequent radiotherapy was applied. PET-MRI visualization revealed the absence of pathological uptake and ruled out any metastatic lesions (). A standard distal pancreatectomy with splenectomy was performed. The pathology results showed complete response to therapy with no signs of malignancy. Currently the patient () is asymptomatic with no evidence of recurrence at 9-month follow-up.
A 46-year-old female presented with jaundice and bilirubin level up to 6.1 mg/dl. Her sister had oncological history of breast cancer. Thoracic-abdominal-pelvic CT was performed and ultrasound-guided fine-needle biopsy was suggestive for adenocarcinoma uT3N1 in the head of pancreas. The patient underwent the placement of biliary metallic stent and received 7 cycles of neoadjuvant therapy with folfirinox and subsequent radiotherapy. The Whipple procedure was performed and pathological examination revealed complete pathologic response (). The adjuvant therapy with Gemcitabine was prescribed. For now, the patient remains asymptomatic and with no signs of tumor recurrence after 15 months of follow-up.