A 72-year-old man presented with a history of abdominal pain, jaundice and weight loss. Laboratory results demonstrated a cholestatic pattern. CA19-9 was 37.8 UI/mL. Diagnostic studies revealed a 1.8 cm pancreatic mass, encasing the porto-splenic confluence (>180°) with attachment to the SMA (<180°) (Figure A,B). Unfortunately, it was not possible to perform a needle biopsy due to technical difficulties. However, images were analyzed by a group of expert radiologists and evaluated with a multidisciplinary team composed of oncologists, gastroenterologists and HPB surgeons, who agreed in the diagnosis of pancreatic cancer.\nA biliary stent was placed, and relief of jaundice was achieved. He then commenced chemotherapy with gemcitabine (1,000 gm/m2) in combination with cisplatin (50 mg/m2) every two weeks. The patient completed three cycles of chemotherapy. During chemotherapy, cross sectional imaging suggested partial tumor regression, with increased patency of PV (compromise <180°) and less compromise of SMA (<90°), with no evidence of metastatic disease. The patient was referred for consolidation radiotherapy, of which he had a total of 50.4 Gy in 30 fractions and infusional 5-fluorouracil (200 mg/m2). He developed no major adverse effects.\nFollow-up CT demonstrated reduction in local disease (Figure C,D). Eleven months after the initial diagnosis the patient underwent surgery with curative intent in the form of a Whipple procedure. He had an uneventful recovery period.\nThe whole pancreatic specimen was sent for pathological examination, processed in blocks of 3 to 4 mm thickness. Macroscopically, there was no evidence of tumor. Sixteen paraffin blocks, 18 slides and 19 sections were reviewed. Further immunohistochemistry failed to confirm a pancreatic carcinoma. These findings were considered as a complete pathological response (Figure ).
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.