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 46-year-old female presented with jaundice and bilirubin level up to 6.1 mg/dl. Her sister had oncological history of breast cancer. Thoracic-abdominal-pelvic CT was performed and ultrasound-guided fine-needle biopsy was suggestive for adenocarcinoma uT3N1 in the head of pancreas. The patient underwent the placement of biliary metallic stent and received 7 cycles of neoadjuvant therapy with folfirinox and subsequent radiotherapy. The Whipple procedure was performed and pathological examination revealed complete pathologic response (). The adjuvant therapy with Gemcitabine was prescribed. For now, the patient remains asymptomatic and with no signs of tumor recurrence after 15 months of follow-up.