Context Pancreatic ductal adenocarcinoma is generally associated with a dismal prognosis even after curative pancreatic resection. Recently, some authors have reported cohort of patients with long survival. Case report A 60-year-old woman underwent pancreaticoduodenectomy (PD) for pancreatic head mass on May 1996. Pathological examination showed a well differentiated ductal adenocarcinoma of 2.5 cm in diameter, limited within the pancreatic gland (T2); loco-regional lymph node metastases (N1) were present and the resection margin was free from carcinoma (R0). The postoperative course was uneventful and 5 weeks after surgery the patient began adjuvant therapy with gemcitabine plus CDDP for 6 cycles. The patient was clinically and CT followed every 3 months for the first year and every 6 months subsequently. Thirteen years later (December 2009), due to an impaired glucose tolerance, without other symptoms, a CT scan showed a cystic lesion with septa of 45 mm in diameter localized in the tail of the pancreas. A FDG-PET resulted positive and on January 2010, the patient underwent surgery. The operation consisted in an en-bloc resection of body-tail of the pancreas, spleen, left adrenal gland and a part of the gastric wall. Pathological examination showed moderately differentiated pancreatic adenocarcinoma, biliopancreatic and intestinal type, invading the peripancreatic fat tissue but without invasion of the gastric wall and adrenal gland (T3); no lymph node metastases (N0) were present. Resections margin were also free from cancer cells (R0). The pathological characteristics of the mass suggest the hypothesis of a pancreatic adenocarcinoma arising from an intraductal papillary mucinous neoplasm (IPMN). The postoperative course was uneventful and at present the patient fourteen years after the first operation is in good general health and cancer free. Conclusion The long-term survival of our patient is probably due to a "non correct" pathological diagnosis at the first operation because IPMNs were not well known. This is also supported by the fact that the IPMN was pathologically diagnosed after the second surgical approach and it is possible that these lesions are slow-growing and may recur in other sites of the pancreatic gland.

Long-Term Survival After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma. Case Report

Ricci C;Taffurelli G;DI MARCO, MARIACRISTINA;MACCHINI, MARINA;CALCULLI, LUCIA;CASADEI, RICCARDO;MINNI, FRANCESCO
2010

Abstract

Context Pancreatic ductal adenocarcinoma is generally associated with a dismal prognosis even after curative pancreatic resection. Recently, some authors have reported cohort of patients with long survival. Case report A 60-year-old woman underwent pancreaticoduodenectomy (PD) for pancreatic head mass on May 1996. Pathological examination showed a well differentiated ductal adenocarcinoma of 2.5 cm in diameter, limited within the pancreatic gland (T2); loco-regional lymph node metastases (N1) were present and the resection margin was free from carcinoma (R0). The postoperative course was uneventful and 5 weeks after surgery the patient began adjuvant therapy with gemcitabine plus CDDP for 6 cycles. The patient was clinically and CT followed every 3 months for the first year and every 6 months subsequently. Thirteen years later (December 2009), due to an impaired glucose tolerance, without other symptoms, a CT scan showed a cystic lesion with septa of 45 mm in diameter localized in the tail of the pancreas. A FDG-PET resulted positive and on January 2010, the patient underwent surgery. The operation consisted in an en-bloc resection of body-tail of the pancreas, spleen, left adrenal gland and a part of the gastric wall. Pathological examination showed moderately differentiated pancreatic adenocarcinoma, biliopancreatic and intestinal type, invading the peripancreatic fat tissue but without invasion of the gastric wall and adrenal gland (T3); no lymph node metastases (N0) were present. Resections margin were also free from cancer cells (R0). The pathological characteristics of the mass suggest the hypothesis of a pancreatic adenocarcinoma arising from an intraductal papillary mucinous neoplasm (IPMN). The postoperative course was uneventful and at present the patient fourteen years after the first operation is in good general health and cancer free. Conclusion The long-term survival of our patient is probably due to a "non correct" pathological diagnosis at the first operation because IPMNs were not well known. This is also supported by the fact that the IPMN was pathologically diagnosed after the second surgical approach and it is possible that these lesions are slow-growing and may recur in other sites of the pancreatic gland.
JOP. JOURNAL OF THE PANCREAS
521
522
Buscemi S; Laterza M; Monari F; D’ambra M; Alagna V; Rega D; Ricci C; Taffurelli G; Pezzilli R; Di Marco M; Macchini M; Calculli L; Santini D; Casadei R; Minni F
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/95074
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