A Highly Responsive Pancreatic Ductal Adenocarcinoma with Liver Metastasis: A Rare Case Report

Yixin Xu,¹ Jianguo Du,¹ Yibo Wang,¹ Bo Gong,² Yue Wang,³ Leiming Qian,⁴ Yulin Tan<sup>1

1</sup>Department of General Surgery, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University; The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, People’s Republic of China; ²Department of Imaging, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University; The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, People’s Republic of China; ³Department of Oncology, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University; The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, People’s Republic of China; ⁴Department of Pathology, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University; The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, People’s Republic of China

Correspondence: Yulin Tan Tel +86-0519-88587142
Email tanyulindoctor@sina.com

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most refractory and lethal cancer. The overall survival is dismal due to the high frequency of recurrence and metastasis after surgery and resistance to chemotherapy. Patients with the locally advanced or metastatic disease usually have the poorest prognosis. Herein, we report a rare highly responsive PDAC with liver metastasis.
Case Presentation: A 49-year-old female presented with dull abdominal and back pain, discomfort after eating, fatigue, and recent weight loss of 5 kg. Clinical examination was normal and no relevant oncological history was observed. A routine blood test showed low red blood cell count and low hemoglobin level. Markedly increased carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 125 levels were detected. Computer tomography (CT) of the abdomen revealed a massive pancreatic tumor with the invasion of almost all important surrounding blood vessels and liver metastasis. After the genetic test and percutaneous biopsy for this tumor, a multidisciplinary team (MDT) discussion was initiated. Subsequently, oral chemotherapy (S-1) and ¹²⁵I radiative seeds implantation were recommended. Surprisingly, the tumor shrank significantly after treatment. On August 14, 2019, pancreatoduodenectomy was performed. The tumor was successfully resected and liver metastasis was not detected. Based on the postoperative histopathological result, there was only fibrous tissue hyperplasia and inflammatory cell infiltration. Besides, no tumor tissue was found. Until now, through outpatient follow-up, no signs of recurrence and metastasis have been observed.
Conclusion: Although the therapeutic efficacy and prognosis of PDAC are dismal, we successfully cured a patient with a metastatic disease through multidisciplinary cooperation. However, the therapeutic experience should be summarized and further research should be performed to confirm whether it is appropriate for other PDAC patients.

Keywords: pancreatic ductal adenocarcinoma, metastasis, diagnosis, chemotherapy, multidisciplinary team