Pancreatic ductal adenocarcinoma with mismatch repair deficiency resected after long-term observation
- PDF / 2,744,166 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 95 Downloads / 224 Views
CASE REPORT
Pancreatic ductal adenocarcinoma with mismatch repair deficiency resected after long‑term observation Nobuhiko Ogasawara1 · Tsunao Imamura1 · Rikako Koyama1 · Naoko Inoshita2 · Atsuhito Nakayama2 · Daisuke Hattori1 · Yasuo Ito1 · Yoshiki Sato1 · Tetsuo Tamura1 · Masaji Hashimoto3 Received: 9 February 2020 / Accepted: 14 April 2020 © Japanese Society of Gastroenterology 2020
Abstract Pancreatic ductal adenocarcinoma (PDAC) with mismatch repair (MMR) deficiency is a rare subtype, clinicopathological features of which have not been fully understood. A 70-year-old woman was admitted for the investigation of a 20-mm pancreatic tumor in the pancreatic head, detected during the cause scrutiny of exacerbation of diabetes mellitus and panhypopituitarism. The tumor decreased in size after administration of hydrocortisone for panhypopituitarism. Autoimmune pancreatitis, complicated with hypophysitis, was suspected, and prednisolone treatment was administered. The tumor did not show enlargement for 3 years during which a dose of prednisolone was maintained. However, 1.5 years after the cessation of prednisolone administration, the tumor size increased again. On endoscopic ultrasonography, the tumor was found to be a 25.2-mm mass lesion with almost uniformly low echogenicity and blood flow signal, and anisonucleosis on cytodiagnosis was revealed. Pancreatoduodenectomy was performed, and on histological analysis, moderately differentiated tubular adenocarcinoma with massive lymphocytic infiltration was observed. Immunohistochemistry revealed a concomitant loss of MSH2 and MSH6 in the tumor cells, which implicated mutant MSH2 gene. She has remained well with no recurrence for 2.9 years since her surgery. We herein report a case of PDAC with MMR deficiency, resected after long-term observation. Keywords Pancreatic neoplasms · DNA mismatch repair · Autoimmune pancreatitis · Hypophysitis
Introduction Pancreatic ductal adenocarcinoma (PDAC) is among the most fatal solid cancers, with little improvement in overall survival achieved in the past few decades [1–3]. The reported recurrence is high, at approximately 80–85%, even after surgery and the majority of the patients succumb to the disease after resection, and 5-year survival rate is lower than 20% [4, 5]. Current research is actively focused on identifying potential new treatment targets and subsets of PDAC patients that may benefit from a specific ‘targeted’ approach. One recently identified subtype within the genomic landscape of
* Tsunao Imamura [email protected] 1
Department of Gastroenterology, Toranomon Hospital, 2‑2‑2 Toranomon, Minato‑ku, Tokyo 105‑0001, Japan
2
Department of Pathology, Toranomon Hospital, Tokyo, Japan
3
Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan
PDAC is the mismatch repair (MMR)-deficient tumor [6–9]. PDAC with MMR deficiency is reported to have high mutation burdens, which has the potential to advance therapeutic development, particularly for immunotherapeutic strategies [9]. Moreover, PDAC wit
Data Loading...
