A 78-year-old man presented with elevated carcinoembryonic antigen (CEA) levels. Abdominal CT revealed a pancreatic tumor, and he was transferred to our hospital. The patient had a history of laparoscopic right hemicolectomy for cecal cancer IIA (T3N0M0) 5 years before admission. He presented with nausea, vomiting, numbness of fingers, and other complaints after two rounds of oxaliplatin combined with capecitabine. The patient refused oxaliplatin and was switched to capecitabine alone for four cycles. Two years before admission, he underwent thoracoscopic left upper lung wedge resection due to lung metastasis of his primary colon cancer. Postoperative pathology and immunohistochemistry suggested that the primary tumor was colon cancer. Oral drug therapy was not continued after surgery and six cycles of capecitabine chemotherapy.
Shortly before admission, the patient’s CEA increased to 9.2 ng/ml (normal 0-5 ng/ml), CA-199: 23.8 U/ml (normal 0-37 U/ml), and AFP: 4.3 ng/ml (normal 0-8.8 ng/ml). No abnormalities in routine complete blood count, liver enzymes, or kidney function were found. A CT at our hospital revealed a pancreatic tumor measuring 5.5 × 2.8 × 2 cm, suggesting a malignancy (Fig. 1A, B).
Because the patient had a previous history of colon cancer and recent CEA elevation, we suspected pancreatic metastatic colon cancer. Because he was found to have no contraindications for surgery, the patient underwent laparoscopic pancreatectomy (combined with splenectomy). No significant adhesions were found in the peripancreatic tissue. The pancreatic body size was approximately 5 × 3 × 2 cm (Fig. 2). The intraoperative frozen sections revealed negative margins. Intraoperative blood loss was 100 ml, and there was no transfusion.
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Postoperatively, there was no pancreatic fistula, abdominal infection, or bleeding. Ten days after the operation, the patient was discharged after removing the drainage tube. One month after the operation, the patient returned to the hospital for an examination. He had no complaints of discomfort. A complete blood count, liver enzymes, and kidney functions were normal. The tumor marker CEA had returned to normal. The postoperative specimen is shown in Fig. 3.
Histopathology and immunohistochemistry revealed pancreatic adenocarcinoma, CDX-2 (+), villin (+), CD20 (+), CK7 (−), CK19 (+), Ki-67 (+) 60%, and Satb2 (+). Our conjecture was confirmed. We performed mutation analysis on 520 cancer-related genes in tumor samples at three loci (Nanjing Shihe gene Bio-Technology Co., Ltd, China). As shown in Table 1, ten appeared in three samples simultaneously among the 21 mutant genes detected. Because the patient refused oxaliplatin, we continued treatment with oral capecitabine. The patient received a total of six cycles of oral capecitabine. No significant adverse drug reactions were observed (Fig. 4).
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