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 56-year-old female presented with a history of breast cancer treated with surgery and chemoradiotherapy 9 years ago. The previous year she started experiencing abdominal pain and the thoracic-abdominal CT scan revealed a solid mass in the pancreas 30×40 mm in size. Ultrasound-guided fine-needle biopsy confirmed adenocarcinoma uT4N1 in the pancreatic neck with vascular infiltration. The patient received neoadjuvant therapy with Gemcitabine and paclitaxel with following radiotherapy. Whipple procedure was performed and the histopathological study revealed pancreatic adenocarcinoma pT3N0. The adjuvant therapy with Gemcitabine was prescribed. The follow up examination identified liver metastases; the BRCA test confirmed the presence of BRAC1 mutation. Finally, the patient received chemotherapy with Folfirinox with good response and no signs of metastatic disease progression.