Preoperatory Gemcitabine and Oxaliplatin in a patient with ovarian metastasis from pancreatic cystadenocarcinoma

We describe a case of clinical benefit and partial response with Gemcitabine and Oxaliplatin (GEMOX) in a young patient with ovarian metastasis from cystadenocarcinoma of the pancreas. A young woman complained of abdominal pain and constipation. Computed tomography (CT) and magnetic resonance imaging (MRI) scans disclosed two bilateral ovarian masses with pancreatic extension. She underwent bilateral ovarian and womb resection. During surgery peritoneal carcinosis, a pancreatic mass and multiple abdominal lesions were found. The final diagnosis was mucinous pancreatic cystadenocarcinoma with ovarian and peritoneal metastases. She started chemotherapy with Gemcitabine 1000 mg/m2/d1 and Oxaliplatin 100 mg/m2/d2 every two weeks (GEMOX). After twelve cycles of chemotherapy a CT scan showed a reduction of the pancreatic mass. She underwent distal pancreatic resection, regional lymphadenectomy and splenectomy. Pathologic examination documented a prominent fibrous tissue and few neoplastic cells with mucin-filled cytoplasm. Chemotherapy was continued with Gemcitabine as “adjuvant treatment” for another three cycles. There is currently no evidence of disease. As reported in literature, GEMOX is associated with an improvement in progression-free survival and clinical benefit in patients with advanced pancreatic cancer. This is an interesting case in which GEMOX transformed inoperable pancreatic cancer into a resectable tumour.