A 58-year-old man presented with weight loss, jaundice and abdominal pain. Laboratory parameters were compatible with obstructive jaundice. CA19-9 was elevated (214 UI/mL). MRI demonstrated a solid tumor at the pancreatic neck. The axial diameter of the tumor was 2.2 cm, encasing the porto-splenic-mesenteric confluence (>180°), with SMV compromise of 18 mm (longitudinal axis) and without compromise of CA and SMA (Figure A,B). There was no evidence of lymph node involvement or metastatic disease. An endoscopic ultrasound-guided fine needle aspiration biopsy was obtained. Pathology revealed a well-differentiated pancreatic adenocarcinoma. At the same time a biliary stent was placed. The patient received three cycles of chemotherapy (gemcitabine: 1,000 mg/m2 and cisplatin: 50 mg/m2) every two weeks. He also commenced radiotherapy (50.4 Gy in 30 fractions) and infusional 5-fluorouracil (200 mg/m2). The dose had to be reduced by 20% due to thrombocytopenia. At the end of treatment, CA19-9 dropped to 124 UI/mL. Follow-up MRI demonstrated further reduction in local disease, with no evidence of porto-mesenteric infiltration (Figure C,D). Based on his remarkable response the decision was made to explore the patient, so he underwent a Whipple procedure with curative intention.\nHistopathological analysis of the specimen demonstrated a 1.5 cm, moderately differentiated pancreatic adenocarcinoma with extensive signs of regression, with multiple microscopic infiltrative foci (Figure ). Surgical margins were free of disease.
A 60-year-old male presented with jaundice and abdominal pain having elevated liver function indices. Abdominal CT scan demonstrated a lesion in the head of the pancreas measuring 37 mm with common bile duct and hepatic duct dilatation and another lesion in liver compatible with metastases. After echoendoscopy, the findings were staged as uT3N1M1 tumor. The biopsy confirmed pancreatic adenocarcinoma. The patient underwent neoadjuvant treatment with gemcitabine and abraxane, after the follow-up examination, this treatment was changed due to suspected progression of the disease regarding the elevation of CA19-9 serum marker; finally, in 2014, the FOLFIRINOX and radiotherapy were prescribed. The laboratory studies revealed BRCA2 mutation. Until 2018, a response to therapy is preserved with no evidence of metastatic disease.