Invasive Ductal Adenocarcinoma of the Remnant Pancreatic Body 9 Years after Resection of an Intraductal Papillary-Mucinous Carcinoma of the Pancreatic Head: a Case Report and Comparison of DNA Sequence in K-ras Gene Mutation

Abstract Background Several studies have suggested a survival benefit of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head. Data concerning NAT for PDAC located in pancreatic body or tail are lacking. Methods Post hoc analysis of an international multicenter retrospective cohort of distal pancreatectomy for PDAC in 34 centers from 11 countries (2007–2015). Patients who underwent resection after NAT were matched (1:1 ratio), using propensity scores based on baseline characteristics, to patients who underwent upfront resection. Median overall survival was compared using the stratified log-rank test. Results Among 1236 patients, 136 (11.0%) received NAT, most frequently FOLFIRINOX (25.7%). In total, 94 patients receiving NAT were matched to 94 patients undergoing upfront resection. NAT was associated with less postoperative major morbidity (Clavien–Dindo ≥ 3a, 10.6% vs. 23.4%, P = 0.020) and pancreatic fistula grade B/C (9.6% vs. 21.3%, P = 0.026). NAT did not improve overall survival [27 (95% CI 14–39) versus 31 months (95% CI 19–42), P = 0.277], as compared with upfront resection. In a sensitivity analysis of 251 patients with radiographic tumor involvement of splenic vessels, NAT (n = 37, 14.7%) was associated with prolonged overall survival [36 (95% CI 18–53) versus 20 months (95% CI 15–24), P = 0.049], as compared with upfront resection. Conclusion In this international multicenter cohort study, NAT for resected PDAC in pancreatic body or tail was associated with less morbidity and pancreatic fistula but similar overall survival in comparison with upfront resection. Prospective studies should confirm a survival benefit of NAT in patients with PDAC and splenic vessel involvement.

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A Case Report of Invasive Ductal Adenocarcinoma Identified in a Lymphatic Channel: A Staging Controversy

Cancer Control ◽

10.1177/107327480301000510 ◽

2003 ◽

Vol 10 (5) ◽

pp. 411-413

Author(s):

James W. Jakub ◽

Francis D. Drake ◽

Andrew W. Pippas ◽

Mary Gardner ◽

Roberto J. Fraile ◽

...

Keyword(s):

Case Report ◽

Ductal Adenocarcinoma ◽

Lymphatic Channel ◽

Invasive Ductal Adenocarcinoma

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Resectable adenocarcinoma developing in the remnant pancreas 7 years after partial pancreatoduodenectomy for invasive ductal adenocarcinoma of the pancreas: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-017-1359-3 ◽

2017 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Lina Frei ◽

Ruedi Stieger ◽

Christian Bayerl ◽

Stefan Breitenstein ◽

Ralph F. Staerkle

Keyword(s):

Case Report ◽

Ductal Adenocarcinoma ◽

Remnant Pancreas ◽

Invasive Ductal Adenocarcinoma ◽

Adenocarcinoma Of The Pancreas ◽

Partial Pancreatoduodenectomy

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Liquid Biopsy Prevents Inaccurate Her2 Status Determination by in situ Hybridization in a Patient with Invasive Ductal Adenocarcinoma of the Breast: Case Report

Case Reports in Oncology ◽

10.1159/000480698 ◽

2017 ◽

Vol 10 (3) ◽

pp. 857-862 ◽

Cited By ~ 2

Author(s):

Yen-Dun Tony Tzeng ◽

Shih-En Chang ◽

Rui Mei ◽

Manana Javey

Keyword(s):

Case Report ◽

Liquid Biopsy ◽

Circulating Tumor Dna ◽

Cancer Surveillance ◽

Ductal Adenocarcinoma ◽

Her2 Status ◽

Noninvasive Test ◽

Cancer Management ◽

Area Of Interest ◽

Invasive Ductal Adenocarcinoma

Utilization of circulating tumor DNA as a novel and noninvasive test for diagnosis confirmation, therapy selection, and cancer surveillance is a rapidly growing area of interest. In the wake of FDA approval of a liquid biopsy test, it is important for clinicians to acknowledge the obvious clinical utility of liquid biopsy for cancer management throughout the course of the disease. This case report describes a female with invasive ductal adenocarcinoma of the breast, where liquid biopsy was instrumental for her cancer characterization and personalized therapy selection.

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Invasive ductal adenocarcinoma arising from pancreatic heterotopia in rectum: case report and review of literature

Human Pathology ◽

10.1016/j.humpath.2010.06.005 ◽

2010 ◽

Vol 41 (12) ◽

pp. 1809-1813 ◽

Cited By ~ 16

Author(s):

Mahmoud Goodarzi ◽

Asif Rashid ◽

Dipen Maru

Keyword(s):

Case Report ◽

Ductal Adenocarcinoma ◽

Review Of Literature ◽

Pancreatic Heterotopia ◽

Invasive Ductal Adenocarcinoma

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Two Case Reports of Resectable Cancer in the Remnant Pancreas after Pancreatectomy for Invasive Ductal Carcinoma of the Pancreas

International Surgery ◽

10.9738/intsurg-d-16-00182.1 ◽

2019 ◽

Vol 103 (11-12) ◽

pp. 542-547

Author(s):

Shinji Iwakura ◽

Yasutsugu Shirai ◽

Tsunehiro Maeda ◽

Toshiji Tominaga ◽

Takayuki Nakase ◽

...

Keyword(s):

Gene Mutation ◽

Invasive Ductal Carcinoma ◽

Ductal Carcinoma ◽

Total Pancreatectomy ◽

Pancreatic Head ◽

Ras Gene ◽

Remnant Pancreas ◽

Exon 1 ◽

Resectable Cancer ◽

Cancerous Cells

Pancreatic cancer has an extremely poor prognosis. There are several reports on resectable cancer in the remnant pancreas after pancreatectomy; however, few have compared K-ras mutation patterns to clarify recurrent or second primary cancers. Here, we report on 2 cases of cancer in the remnant pancreas after total pancreatectomy for invasive ductal carcinoma. Case 1 is a 56-year-old man who underwent pancreaticoduodenectomy for cancer of the pancreatic head. However, serum carbohydrate antigen (CA19-9) was again elevated 23 months later. A tumor in the pancreatic tail was detected on abdominal computed tomography (CT), and total pancreatectomy was performed. Histologic examination of the tumors from both operations revealed moderately differentiated adenocarcinoma, and the surgical margins of both resected specimens were free of cancerous cells. The K-ras gene mutation was detected at codon 12V of exon 1 in both cancers. Case 2 is a 72-year-old woman who underwent distal pancreatectomy for cancer of the pancreatic body. However, serum CA19-9 was again elevated 4 years postoperatively. A tumor of the pancreatic head was detected on abdominal CT, and total pancreatectomy was performed. Histologic examination of the first and second tumors revealed poorly and moderately differentiated adenocarcinomas, respectively. The surgical margins of both resected specimens were free of cancerous cells. The K-ras gene mutation was detected at codon 12D of exon 1 in both cancers. These patients with rare pancreatic cancers both had metachronous carcinogenesis in the remnant pancreas.

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Three Curative Pancreatectomies for the Metachronous Appearance of Pancreatic Invasive Ductal Adenocarcinoma

Case Reports in Oncology ◽

10.1159/000506732 ◽

2020 ◽

Vol 13 (1) ◽

pp. 392-397

Author(s):

Yusuke Miyagawa ◽

Masato Kitazawa ◽

Hiroe Kitahara ◽

Yukihiko Karasawa ◽

Takashi Orii ◽

...

Keyword(s):

Ductal Adenocarcinoma ◽

Pancreatic Metastasis ◽

Cystic Tumor ◽

Second Primary ◽

Tubular Adenocarcinoma ◽

Primary Cancer ◽

The Third ◽

Pancreatic Body ◽

Resected Tumor ◽

Invasive Ductal Adenocarcinoma

We report a rare case of a patient who underwent 3 successful curative operations for the metachronous appearance of pancreatic cancer. In July 2007, a 54-year-old woman underwent pylorus-preserving pancreaticoduodenectomy. In March 2010, a tumor measuring 9 mm in diameter was detected in the tail of the pancreas on computed tomography (CT) and magnetic resonance imaging. The pancreas tail was subsequently resected while preserving the pancreatic body. In February 2011, CT revealed a cystic tumor measuring 2.5 cm in diameter in the remnant pancreatic body without any metastasis; therefore, total resection of the residual pancreas was performed in April 2011. The first resected tumor was histopathologically diagnosed as undifferentiated adenocarcinoma with osteoclast-like giant cells. Additionally, the third resected tumor had similar undifferentiated components. Contrarily, the second resected tumor was diagnosed as a well-differentiated tubular adenocarcinoma. We consider that the tumor from the third operation was an intra-pancreatic metastasis of the primary cancer and that the tumor from the second operation was the second primary cancer. The patient responded well with good control of surgical diabetes for 92 months since the last pancreatectomy. This case suggested that aggressive repeated resection for recurrent pancreatic invasive ductal adenocarcinoma is beneficial in limited cases.

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A Case of Syncronised Hereditery Nonpoliposis Colorectal Tumor With Different Hystopathological Type and K-Ras Gene Mutation: Case Report

Journal of Clinical Medicine Research ◽

10.4021/jocmr1123w ◽

2013 ◽

Author(s):

Dinc

Keyword(s):

Case Report ◽

Gene Mutation ◽

Colorectal Tumor ◽

Ras Gene

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Comparative genomic analysis of head and body/tail of pancreatic ductal adenocarcinoma at early and late stages

10.21203/rs.3.rs-36713/v1 ◽

2020 ◽

Author(s):

Xueyou Zhang ◽

Shi Feng ◽

Qian Wang ◽

Haitao Huang ◽

Qinfen Xie ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Mutation Rate ◽

Molecular Diversity ◽

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

Comparative Genomic ◽

Fisher Exact Test ◽

Genomic Alterations ◽

Pancreatic Body ◽

Late Stages

Abstract Background Pancreatic ductal adenocarcinoma (PDAC), one of the most lethal human cancers, can be divided into head and body/tail cancers according to the anatomy. We previously reported a prognostic relevance of tumor location in resectable PDAC. This study is aimed to further explore the mechanism underlying the molecular diversity between the head and body/tail of PDACs. Methods We detected tumor genomes in 154 resectable (surgery) and non-resectable (biopsy) PDACs using a next-generation sequencing panel. Wilcoxon rank test or Fisher exact test was used for evaluating associations between clinical characteristics, mutation frequency, and survival probability between the two cohorts. Results Compared with pancreatic head cancers, pancreatic body/tail cancers showed significantly more enriched genomic alterations in KRAS (97.1% vs. 82.4%, p = 0.004) and SMAD4 (42.0% vs. 21.2%, p = 0.008). At early stages (I-II), the SMAD4 mutation rate was significantly higher in pancreatic body/tail cancers than pancreatic head cancers (56.0% vs. 26.5%, p = 0.021). At late stages (III-IV), pancreatic body/tail cancers presented significantly higher KRAS mutation rate (100.0% vs. 75.8%, p = 0.001), higher frequency of MAPK pathway mutation (100% vs. 87.8%, p = 0.040) and lower rates of druggable genomic alterations (30.8% vs. 57.6%, p = 0.030) than pancreatic head cancers. Conclusions The molecular diversity exists between pancreatic head and body/tail cancers in both tumor initiation and progression. Pancreatic body/tail cancer seems to be more malignant than pancreatic head cancer at late stages.

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