Nakamura Kenichi, Nakagawa Mitsuru, Ariga Mizuki, Higashiguchi Takahiko, Chikaishi Yuko, Matsuo Kazuhiro, Nishijima Aki, Endo Tomoyoshi, Kikuchi Kenji, Morohara Koji, Katsuno Hidetoshi, Tachi Yoshihiko, Uyama Ichiro, Suda Koichi, Morise Zenichi
Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan.
Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Surg Case Rep. 2024 Aug 16;10(1):189. doi: 10.1186/s40792-024-01989-5.
Adenosquamous carcinoma of the pancreas (ASCP) accounts for only 1-4% of all pancreatic exocrine cancers and has a particularly poor prognosis. The efficacy of chemotherapy for ASCP remains unknown because of the small number of cases, and few studies have evaluated conversion-intended chemotherapy.
A 76-year-old woman was referred to our hospital because of epigastric pain and nausea. A preoperative contrast-enhanced multidetector row computed tomography (MDCT) scan revealed a 17 × 17 mm low-density tumor with an ill-defined margin at the arterial phase in the pancreatic head. The tumor involved the common hepatic artery, left hepatic artery bifurcated from the common hepatic artery, and gastroduodenal artery, and was in contact with the portal vein. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed an uptake in the pancreatic head but no evidence of distant metastasis. The tumor was diagnosed as an adenocarcinoma of the pancreatic head and staged unresectable because the common and left hepatic arteries were involved. Hence, the patient underwent seven courses of conversion-intended chemotherapy using gemcitabine and nab-paclitaxel for pancreatic ductal adenocarcinoma over 7 months. After chemotherapy, the tumor shrank to 10 × 10 mm on contrast-enhanced MDCT. Consequently, the boundary between the tumor and major vessels of the common and left hepatic arteries and the portal vein became clear, and the involvement of the arteries with the tumor was evaluated to be released. The contact of the tumor to the portal vein also reduced to less than half the circumference of the portal vein. FDG-PET showed decreased accumulation in the tumor. Hence, the tumor was judged resectable, and pancreaticoduodenectomy was performed. The tumor and major blood vessels were easily dissected and R0 resection was achieved. The patient experienced no major complications and was discharged on postoperative day 28. The tumor was revealed as ASCP via pathological examination. The patient is alive and recurrence-free seven months after surgery. This is the first report of successful R0 resection for an initially unresectable ASCP following conversion-intended chemotherapy using gemcitabine and nab-paclitaxel regimen.
Conversion-intended chemotherapy using gemcitabine and nab-paclitaxel regimen may be effective for ASCP.
胰腺腺鳞癌（ASCP）仅占所有胰腺外分泌癌的1%-4%，预后特别差。由于病例数量少，ASCP化疗的疗效尚不清楚，很少有研究评估以转化为目的的化疗。
一名76岁女性因上腹部疼痛和恶心被转诊至我院。术前多排螺旋CT增强扫描显示胰头动脉期有一个17×17mm的低密度肿瘤，边界不清。肿瘤累及肝总动脉、从肝总动脉分出的左肝动脉和胃十二指肠动脉，并与门静脉相邻。氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示胰头有摄取，但无远处转移证据。肿瘤被诊断为胰头腺癌，由于肝总动脉和左肝动脉受累，分期为不可切除。因此，患者在7个月内接受了7个疗程以转化为目的的化疗，使用吉西他滨和纳米白蛋白结合型紫杉醇治疗胰腺导管腺癌。化疗后，增强MDCT显示肿瘤缩小至10×10mm。因此，肿瘤与肝总动脉、左肝动脉和门静脉等主要血管之间的边界变得清晰，评估肿瘤对动脉的侵犯已解除。肿瘤与门静脉的接触也减少至门静脉周长的一半以下。FDG-PET显示肿瘤内的积聚减少。因此，判断肿瘤可切除，遂行胰十二指肠切除术。肿瘤和主要血管很容易分离，实现了R0切除。患者未出现重大并发症，术后第28天出院。病理检查显示肿瘤为ASCP。患者术后7个月存活且无复发。这是首例使用吉西他滨和纳米白蛋白结合型紫杉醇方案进行以转化为目的的化疗后成功R0切除初始不可切除ASCP的报告。
使用吉西他滨和纳米白蛋白结合型紫杉醇方案进行以转化为目的的化疗可能对ASCP有效。
