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.
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.