Clear Cell Carcinoma of the Pancreas Infiltrating Duodenum: A Case Report of a Multiface Aspect of an Intriguing Entity

Background: Although Clear-cell carcinoma has been found in various organs as a variant of ductal carcinoma of the pancreas, it still hasn’t been well recognized. According to the WHO classification, primary Clear-cell carcinoma of the pancreas is rare, and it is classified as a “miscellaneous” carcinoma. To date it has been poorly characterized and only few cases have been reported in the literature [1]. Case presentation: We report here an unusual case of Clear-cell carcinoma in a 59-year-old man involving the head of the pancreas and the second part of the duodenum initially misconceived as pyloric gland adenoma, a rare duodenal entity. Nevertheless, duodenal sub stenosis was suspected of malignancy, so further investigations were made. Subsequent abdominal computed tomography (CT) detected not only a duodenal vegetation but also an alteration of the duodenal-pancreatic interface with thickening of the duodenal wall and a common bile duct dilatation. The malignant clinical aspect and behavior of the lesion, associated to the impossibility of further investigations due to the duodenal sub stenosis, led to an exploratory laparotomy.The laparotomy revealed a retracting area straddling the duodenum and the pancreatic head. A duodenum pancreatectomy of the head of the pancreas with extended lymphadenectomy was performed and the histological evaluation showed a ductal Clear-cell adenocarcinoma of the pancreas infiltrating the duodenum. The postoperative course was characterized by a pancreatic fistula grade B. At 6 months from the surgery, the patient hasn’t had recurrence.Conclusion: Because it is a rare tumor with very few cases reported previously, the incidence and prognosis are not well known for this neoplasm. The report of our case would aid in the identification of this rare neoplasm. Further studies and more case reports are needed to clarify the diagnosis and prognostic significance of the clear cell differentiation of these tumors.

Management of Primary Squamous Cell Carcinoma of the Pancreas: A Case Report

Introduction: Primary squamous cell carcinoma of the pancreas (SCCP) is a rare malignant tumor that has been reported in individual case reports only. The clinical data on primary SCCP treatment are limited. Therefore, the appropriate management strategy for this disease should be standardized.Case Presentation: We present the case of a 63-year-old man admitted to our hospital for upper left abdominal pain for 2 months without weight loss or jaundice. Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed a mixed solid and cystic lesion in the pancreatic tail, measuring 35 × 37 mm in maximum diameter with enhancement. The patient was diagnosed with primary SCCP without metastasis, based on radiological and pathological findings. He did not receive neoadjuvant therapy postoperatively and was followed up by CT and MRI for 18 months without recurrence or metastasis.Result: Complete resection is the most effective treatment for early stage primary SCCP. Abdominal MRI is an effective imaging tool for preoperative evaluation and postoperative follow-up of primary SCCP. The need for neoadjuvant therapy depends on various factors.Conclusion: Primary SCCP is a tumor with poor prognosis. Risk factor control, early accurate radiologic evaluation, and individualized treatment strategies improve the quality of life and prolong the overall survival period of patients.

Tri-modal management of primary small cell carcinoma of the pancreas (SCCP): a rare neuroendocrine carcinoma (NEC)

Background Primary small cell carcinoma of the pancreas (SCCP) is a rare malignant neuroendocrine carcinoma (NEC). Typically, it presents with lymphovascular invasion as well as metastasis at the time of diagnosis which portends a dismal prognosis. Treatment is typically based on therapy used for other aggressive NECs such as small cell lung cancer. Although multimodal surgery, radiation and chemotherapy may improve prognosis, the outcome generally remains poor. Case presentation Here we present a primary SCCP managed with neoadjuvant multi-agent chemotherapy combined with radiotherapy and surgery Conclusions Multi-disciplinary therapy resulted in an ongoing 28 + month radiographic complete response and overall survival.

Adenosquamous and squamous cell carcinoma of the pancreas: two histopathological variants of ductal adenocarcinoma

Introduction: Primary squamous cell carcinoma (SCC) and adenosquamous carcinoma of the pancreas are rare malignancies for which diagnostic and treatment strategy are challenging. In this paper we present a literature review of these tumors based on two case reports. Case presentation: In the first case, a 55-year-old male presented with an inoperable pancreatic head/body junction tumor. Endoscopic ultrasound-guided fine needle aspiration was practiced, and histopathological examination revealed a squamous cell carcinoma of the pancreas. After exclusion of any another tumor, the diagnosis of cT4N0M0-staged primary pancreatic SCC was made. The patient is under treatment with gemcitabine and oxaliplatin. The second case is represented by a 73-year-old patient in which imagistic examinations highlighted a cystic mass of the pancreatic body. Following coporeo-caudal splenic-pancreatectomy and histopathological-proved diagnosis of adenosquamous carcinoma, the patient started chemotherapy but died at 11 months after surgery. Both tumor components displayed positivity for markers which prove ductal (cytokeratin19, maspin) and squamous differentiation (p63, cytokeratin5/6) same as vimentin, as indicator of epithelial mesenchymal transition (EMT). Conclusions: SCC and adenosquamous carcinoma of the pancreas are aggressive malignancies which prognosis remains highly reserved. These tumors might be variants of ductal adenocarcinomas which are dedifferentiated through EMT phenomenon.