Resectable adenocarcinoma developing in the remnant pancreas 7 years after partial pancreatoduodenectomy for invasive ductal adenocarcinoma of the pancreas: a case report

J Med Case Rep. 2017 Jul 17;11(1):194. doi: 10.1186/s13256-017-1359-3.

Abstract

Background: Pancreatic adenocarcinoma still has an excessively high mortality rate and resection is the only potentially curative treatment. The postoperative 5-year survival rate is approximately 20% and recurrence develops generally within 2 years. We report a case of a localized recurrent pancreatic adenocarcinoma in the remnant pancreas, 7 years after initial resection.

Case presentation: In 2008 an abdominal computed tomography scan showed a mass in the pancreas of a 70-year-old white woman, who presented with occlusive jaundice and abdominal pain in her right upper quadrant. A pancreatoduodenectomy was performed for a clinically suspected pancreatic adenocarcinoma. Histology confirmed a ductal adenocarcinoma. Afterwards, she received adjuvant chemotherapy with gemcitabine. In 2015 a follow-up positron emission tomography-computed tomography scan showed a single lesion in her remnant pancreas. Subsequently, a partial re-resection was performed. Histology confirmed once again a ductal adenocarcinoma. She received adjuvant chemotherapy with gemcitabine again and is still alive almost 9 years after she had first been diagnosed as having pancreatic cancer.

Conclusions: In selected cases re-resection for pancreatic recurrence is feasible and provides a survival benefit. In cases involving late recurrence, it is difficult to distinguish between true recurrence and the development of a new tumor. In order to detect recurrences at an early stage in long-term survivors, follow-up needs to occur on a regular and long-term basis.

Keywords: Long-term survivors; Recurrent pancreatic adenocarcinoma; Repeat pancreatectomy.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / therapy
  • Aged
  • Antimetabolites, Antineoplastic / therapeutic use
  • Chemotherapy, Adjuvant*
  • Deoxycytidine / analogs & derivatives
  • Deoxycytidine / therapeutic use
  • Female
  • Humans
  • Neoplasm, Residual
  • Neoplasms, Second Primary / pathology*
  • Neoplasms, Second Primary / therapy
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / pathology*
  • Pancreatic Neoplasms / therapy
  • Pancreaticoduodenectomy*
  • Positron Emission Tomography Computed Tomography
  • Time Factors

Substances

  • Antimetabolites, Antineoplastic
  • Deoxycytidine
  • gemcitabine