PMC3806674_01
a PET/CT showing the primary tumor in the pancreatic head, 3 cm in diameter with weak fluorodeoxyglucose avidity (standard uptake value 3.8; arrowheads). In addition, a large liver metastasis can be seen in the left liver lobe (arrow). b Multiple large liver metastases are shown predominantly in the right liver lobe.
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F1
A 15-year-old boy presented in November 2009 with a 3.2-cm tumor of the head of the pancreas and multiple diffuse liver metastases (fig. 1a, b).
Histopathological findings of pancreas and liver resection specimens. a Overview of the pancreas; resection after chemotherapy. The tumor shows both acinar cell differentiation (left) and ductal differentiation (right), as well as regressive changes (scale bar = 2 mm). b High-power view of the former picture (scale bar = 1 mm). c Perineural infiltration by the acinar cell tumor component. The arrow points to the peripheral nerve (scale bar = 0.8 mm). d Mostly regressive perihilar lymph node metastasis (arrows); resection after chemotherapy (scale bar = 10 mm). e High-power view of the former picture showing few ductal differentiated vital tumor deposits in a regressive background (scale bar = 0.5 mm). f Overview of a liver metastasis with cystic regressive areas with hemorrhage; resection after chemotherapy (scale bar = 10 mm). g Overview of another liver metastasis (arrows); resection after chemotherapy (scale bar = 10 mm). h High-power view of the former picture shows a tumor with blastomatous features (scale bar = 1 mm). i MIB-1 staining reveals a high-proliferation rate of the blastomatous tumor component (scale bar = 0.9 mm).
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F2
Some tumor regression due to the preceding neoadjuvant chemotherapy was observed (fig. 2a-i).
a PET/CT showing multiple new fluorodeoxyglucose avid lung metastases. No relapse could be seen in the abdomen. b Complete metabolic response of the lesions after treatment with FOLFIRINOX.
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F3
After six biweekly cycles, PET/CT showed a complete metabolic and partial morphologic remission of all lung lesions (fig. 3a, b).