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 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.