Gapizov Abubakar, Khan Hadequa Noor, Subhan Muhammad, Bibi Ruqiya, Aqeel Ahsan
Internal Medicine, Weill Cornell Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA.
Medicine, Karachi Medical and Dental College, Karachi, PAK.
Cureus. 2025 May 8;17(5):e83706. doi: 10.7759/cureus.83706. eCollection 2025 May.
Pancreatic adenocarcinoma remains a highly fatal cancer, especially when classified as borderline resectable, characterized by limited involvement of surrounding major blood vessels that challenges but does not absolutely preclude curative surgical resection. We report the case of a 65-year-old male with a history of smoking who presented with progressive, painless jaundice, pruritus, and weight loss over 15 months. Imaging revealed intrahepatic biliary dilation, a distal common bile duct stricture, and a mass in the pancreatic head with peripancreatic lymphadenopathy. Endoscopic intervention confirmed malignant features, and stenting was performed. Subsequent cross-sectional imaging demonstrated a 3.5 cm pancreatic head mass with a 180-degree encasement of the superior mesenteric artery and aortic abutment. Carcinoembryonic antigen 19-9 (CA 19-9) was markedly elevated at 12,000 U/mL. Endoscopic ultrasound-guided biopsy confirmed pancreatic ductal adenocarcinoma. Immunohistochemical staining was positive for cytokeratin 7 and negative for CK20, supporting the pancreatic origin. The patient received six cycles of neoadjuvant-modified folinic acid (leucovorin), fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX), resulting in radiographic tumor shrinkage to 2.4 cm and a biochemical response. Stereotactic body radiation therapy (35 Gy in five fractions) focused on the vascular margin. Surgical resection via pylorus-preserving pancreaticoduodenectomy achieved R0 margins without metastasis. Postoperative recovery was uncomplicated, and the final pathology showed ypT2N1 disease with a 60% treatment response. Adjuvant chemotherapy with gemcitabine and capecitabine was initiated, and tumor markers normalized on follow-up. This case highlights the importance of a multidisciplinary, staged treatment approach in managing borderline resectable pancreatic cancer to optimize resectability and long-term outcomes.
胰腺腺癌仍然是一种高度致命的癌症，尤其是当被归类为可切除边缘型时，其特征是周围主要血管受累有限，这对根治性手术切除构成挑战，但并非绝对排除。我们报告了一例65岁有吸烟史的男性患者，他在15个月内出现进行性、无痛性黄疸、瘙痒和体重减轻。影像学检查显示肝内胆管扩张、肝外胆管远端狭窄以及胰头肿块伴胰周淋巴结肿大。内镜干预证实为恶性特征，并进行了支架置入术。随后的横断面成像显示胰头有一个3.5 cm的肿块，肠系膜上动脉被180度包绕，且与主动脉毗邻。癌胚抗原19-9（CA 19-9）显著升高，达12000 U/mL。内镜超声引导下活检证实为胰腺导管腺癌。免疫组化染色细胞角蛋白7阳性，CK20阴性，支持肿瘤起源于胰腺。患者接受了六个周期的新辅助改良亚叶酸（甲酰四氢叶酸）、氟尿嘧啶、伊立替康和奥沙利铂（FOLFIRINOX）治疗，影像学检查显示肿瘤缩小至2.4 cm，并有生化反应。立体定向体部放射治疗（分五次给予35 Gy）针对血管边缘。通过保留幽门的胰十二指肠切除术进行手术切除，切缘达到R0且无转移。术后恢复顺利，最终病理显示ypT2N1疾病，治疗反应率为60%。开始使用吉西他滨和卡培他滨进行辅助化疗，随访时肿瘤标志物恢复正常。该病例强调了多学科、分阶段治疗方法在处理可切除边缘型胰腺癌以优化可切除性和长期预后方面的重要性。
