PMC8645965_01
(A, B) pancreatic ductal adenocarcinoma. (A) 200X, (B) 400X. The pancreatic head puncture smear showed significant atypical epithelial mass, irregular nuclei, which was consistent with the changes of adenocarcinoma. (C-F) PET/CT images in April 2020. (C) showed a 6.0cm *6.0 cm mass in pancreatic head (arrow); (D) confirmed enlarged lymph nodes in pancreatic head (arrow), and low-density shadows in liver (within cycle); panels (E, F) revealed enlarged multiple lymph nodes in different sizes in retroperitoneum (arrow).
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Pathology diagnosis was pancreatic ductal adenocarcinoma (stage IV) ( Figures 1A, B ). In April 2020, positron emission tomography/computed tomography (PET/CT) revealed a 6.0 cm x 6.0 cm mass in pancreatic head, multiple enlarged lymph nodes in different sizes were found in pancreatic head and retroperitoneum, and multiple low-density shadows in the liver ( Figures 1C-F ).
Enhanced CT images. The pancreatic mass indicated by the arrow on upper-abdomen enhanced CT took in June 2020 (A), in August 2020 (B), in October 2020 (C) and in November 2020 (D). The pancreatic cancer was responded to chemotherapy initially, but the disease was still progressed at later time. After sintilimab combined with S-1 treatment, the pancreatic lesion was significantly reduced in, and nearly disappeared in June 2021 (E). The hepatic metastases indicated by the arrows on upper-abdomen enhanced CT took in October 2020 (F), and in June 2021 (G). The hepatic metastasis was significantly reduced (G).
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In June 2020, after 4 cycles of chemotherapy, upper-abdomen enhanced CT revealed that the size of pancreatic head lesion was significantly decreased to 2.3 cm x 2.5 cm ( Figure 2A ), more that 50% decrease, and multiple low-density shadows in the liver. The patient was repeated CT about every two months ( Figures 2B, C ). October 2020, the patient underwent one cycle of Olaparib by himself, although he did not have the targeted drug-related gene mutation. On October 16, his abdomen enhanced CT scan revealed multiple liver metastases ( Figure 2F ), and the largest measured 2.3 cm. In November 2020, the abdomen enhanced CT scan revealed progressive disease ( Figure 2D ), and the size of the pancreatic head lesion was 6.4 cm. The abdomen enhanced CT scan showed that the intrahepatic metastases ( Figure 2G ) and pancreatic head lesion ( Figure 2E ) were significantly reduced (the size of the pancreatic head lesion was 1 cm).
Timeline of the treament. The patient was diagnosed with pancreatic cancer in September 2019, and received chemotherapy (AG) in October 2019. Before receiving immunotherapy in November 2020, the patient had undergone multi-line chemotherapy (including AG, FOLFIRINOX, AG). And until August 2021 (the latest follow-up), the patient was still receiving immunotherapy combined with chemotherapy.
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The patient did not come to our hospital again until June 2021 ( Figure 3 ).