A 72-year-old man presented with a history of abdominal pain, jaundice and weight loss. Laboratory results demonstrated a cholestatic pattern. CA19-9 was 37.8 UI/mL. Diagnostic studies revealed a 1.8 cm pancreatic mass, encasing the porto-splenic confluence (>180°) with attachment to the SMA (<180°) (Figure A,B). Unfortunately, it was not possible to perform a needle biopsy due to technical difficulties. However, images were analyzed by a group of expert radiologists and evaluated with a multidisciplinary team composed of oncologists, gastroenterologists and HPB surgeons, who agreed in the diagnosis of pancreatic cancer.\nA biliary stent was placed, and relief of jaundice was achieved. He then commenced chemotherapy with gemcitabine (1,000 gm/m2) in combination with cisplatin (50 mg/m2) every two weeks. The patient completed three cycles of chemotherapy. During chemotherapy, cross sectional imaging suggested partial tumor regression, with increased patency of PV (compromise <180°) and less compromise of SMA (<90°), with no evidence of metastatic disease. The patient was referred for consolidation radiotherapy, of which he had a total of 50.4 Gy in 30 fractions and infusional 5-fluorouracil (200 mg/m2). He developed no major adverse effects.\nFollow-up CT demonstrated reduction in local disease (Figure C,D). Eleven months after the initial diagnosis the patient underwent surgery with curative intent in the form of a Whipple procedure. He had an uneventful recovery period.\nThe whole pancreatic specimen was sent for pathological examination, processed in blocks of 3 to 4 mm thickness. Macroscopically, there was no evidence of tumor. Sixteen paraffin blocks, 18 slides and 19 sections were reviewed. Further immunohistochemistry failed to confirm a pancreatic carcinoma. These findings were considered as a complete pathological response (Figure ).
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.