Department of Surgery, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shimizu-ku, Shizuoka, 424-8636, Japan.
Department of Gastroenterology, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shimizu-ku, Shizuoka, 424-8636, Japan.
BMC Gastroenterol. 2020 Jul 11;20(1):220. doi: 10.1186/s12876-020-01362-4.
Therapy targeting programmed death-1 or programmed death-1 ligand-1 (PD-1/PD-L1) has been developed for various solid malignant tumors, such as melanoma and non-small-cell lung cancer (NSCLC), but this approach has little effect in the treatment of pancreatic cancer. Pancreatic undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) is a rare pancreatic malignancy having unique morphology and is considered a variant of pancreatic ductal adenocarcinoma (PDAC). Although UCOGC has been reported to have better prognosis than conventional PDAC, the optimal treatment for UCOGC with distant metastases has not been determined.
A 66-year-old man was initially diagnosed with NSCLC with multiple intrapulmonary metastases and abdominal lymph node metastasis in the tail of the pancreas, and bronchial biopsy and diagnostic imaging were performed. Pathologic examination of the lung showed poorly differentiated adenocarcinoma cells expressing epithelial marker and PD-L1. Therefore, pembrolizumab monotherapy for NSCLC was given. The pulmonary lesions shrank markedly and were in complete remission after 8 months of anti-PD-1 therapy, though no therapeutic effect was observed in the pancreatic site. Distal pancreatectomy was then performed, and histopathological examination showed that the tumor was UCOGC originating from the pancreas. The histologic findings of the resected specimen mimicked those of the lung biopsy specimen, leading to the final assessment that the lung tumors were metastatic foci that migrated from the UCOGC, and only the metastatic lesions benefited from pembrolizumab therapy.
Immune checkpoint inhibitors have limited therapeutic effects on primary lesions of pancreatic cancer, but they may exert antitumor effects on pulmonary metastases of UCOGC.
针对程序性死亡受体-1 或程序性死亡受体配体-1（PD-1/PD-L1）的治疗方法已被开发用于治疗各种实体恶性肿瘤，如黑色素瘤和非小细胞肺癌（NSCLC），但在胰腺癌治疗中效果甚微。伴有破骨样巨细胞的胰腺未分化癌（UCOGC）是一种罕见的胰腺恶性肿瘤，具有独特的形态，被认为是胰腺导管腺癌（PDAC）的一种变体。尽管已有报道称 UCOGC 的预后优于常规 PDAC，但对于远处转移的 UCOGC 的最佳治疗方法尚未确定。
一名 66 岁男性最初被诊断为 NSCLC，伴有多个肺内转移灶和胰腺尾部腹部淋巴结转移，进行了支气管活检和诊断性影像学检查。肺部的病理检查显示低分化腺癌细胞表达上皮标志物和 PD-L1。因此，给予了帕博利珠单抗单药治疗 NSCLC。经过 8 个月的抗 PD-1 治疗后，肺部病变显著缩小并完全缓解，而胰腺部位未见治疗效果。随后进行了远端胰腺切除术，组织病理学检查显示肿瘤为源自胰腺的 UCOGC。切除标本的组织学表现类似于肺活检标本，最终评估认为肺部肿瘤是源自 UCOGC 的转移灶，只有转移性病变从帕博利珠单抗治疗中获益。
免疫检查点抑制剂对胰腺癌的原发性病变治疗效果有限，但它们可能对 UCOGC 的肺转移灶发挥抗肿瘤作用。
