Complete response of a pancreatic adenosquamous carcinoma to chemoradiotherapy

Shibagaki, Kotaro; Fujita, Köichi; Nakayama, Shinji; Takenaka, Mamoru; Fukuba, Nobuhiko; Matsui, Saori; Ozaka, Masato; Yoshinaga, Hiroshi; Masuzawa, Akira; Watanabe, Akihiko; Fujiwara, Hitoshi; Sugawara, Atsushi; Fujita, Tsuyoshi; Mukai, Hidekazu; Kinoshita, Yoshikazu

doi:10.1007/s10147-007-0690-x

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…There have been several case reports and a few case series reporting on PASC [6,11,15-33]. To our knowledge, this study is the largest single institution study (n = 38) to specifically examine the impact of adjuvant chemoradiation on outcome of patients with resected PASC.…”

Section: Discussionmentioning

confidence: 99%

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Resected pancreatic adenosquamous carcinoma: clinicopathologic review and evaluation of adjuvant chemotherapy and radiation in 38 patients

et al. 2010

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Summary Pancreatic adenosquamous carcinoma is a rare morphological variant of pancreatic adenocarcinoma with an especially poor prognosis. The purpose of this study is to identify clinicopathologic features associated with prognosis, assess whether the percentage of squamous differentiation in pancreatic adenosquamous carcinoma is associated with an inferior prognosis, and examine the impact of adjuvant chemoradiation therapy on overall survival. Forty-five (1.2%) of 3651 patients who underwent pancreatic resection at the Johns Hopkins Hospital, Baltimore, MD, between 1986 and 2007 were identified with adenocarcinoma of the pancreas with any squamous differentiation. All pathologic specimens were re-reviewed. Statistical analyses were performed on the 38 patients amenable to adjuvant chemoradiation therapy for whom clinical outcome data could be obtained. Median age was 68 years (61% male). Sixty-one percent underwent pancreaticoduodenectomy. Median tumor size was 5.0 cm. Seventy-six percent of carcinomas were node positive, 37% were margin-positive resections, and 68% had 30% or more squamous differentiation. Median overall survival of the pancreatic adenosquamous carcinoma cohort was 10.9 months (range, 2.1-140.6 months; 95% confidence interval, 8.2-12.5 months). Adjuvant chemoradiation therapy was associated with superior overall survival in patients with pancreatic adenosquamous carcinoma (P = .005). Adjuvant chemoradiation therapy was associated with improved survival in patients with tumors 3 cm or larger and vascular or perineural invasion (P = .02, .03, .02, respectively). The proportion of squamous differentiation was not associated with median overall survival (<30% versus ≥30%, P = .82). Survival after pancreatic resection of pancreatic adenosquamous carcinoma is poor. Treatment with adjuvant chemoradiation therapy is associated with improved survival. The proportion of squamous differentiation in resected pancreatic adenosquamous carcinoma specimens does not appear to impact overall survival.

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Section: Discussionmentioning

confidence: 99%

“…In addition, the optimal management of these patients in the postoperative adjuvant period remains poorly defined. Only a few anecdotal studies regarding the efficacy of adjuvant chemotherapy and radiation treatment of PASC have been published [5,6,10,11]. …”

Section: Introductionmentioning

confidence: 99%

Resected pancreatic adenosquamous carcinoma: clinicopathologic review and evaluation of adjuvant chemotherapy and radiation in 38 patients

et al. 2010

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“…PASC regimens are proposed in accordance with those of pancreatic adenocarcinoma, including a monotherapy of S-1, or a combination therapy of S-1 plus gemcitabine, or an S-1 plus platinum-and/or a paclitaxel-based chemotherapy [12][13][14][15]. Squamous carcinoma is considered to be susceptible to radiation therapy, and postoperative radiation therapy has been found to yield some favorable results [16].…”

Section: Discussionmentioning

confidence: 99%

Adenosquamous Carcinoma of the Pancreas That Had Penetrated Into the Stomach and Transverse Colon: A Case Report

Takeuchi¹,

Emori²,

Yoshitani³

et al. 2017

J Med Cases

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We report the case of pancreatic adenosquamous carcinoma (PASC) that had penetrated into the stomach and transverse colon. A 55-yearold male presented to our hospital with general fatigue, melena, and left flank pain. He had no relevant medical history. A laboratory analysis upon arrival revealed marked anemia with a red blood cell count of 13.3 × 10 4 /μL and a hemoglobin level of 3.6 g/dL. There was tenderness over the upper abdomen and a palpable mass on his left upper abdomen. He was admitted for further examination of his severe anemia and abdominal symptoms. Contrast-enhanced computed tomography revealed multiple liver masses and a 10 cm sized tumor in the pancreas tail involving the gastric wall and transverse colon. Upper gastroendoscopy revealed a 4 cm sized elevated tumor with a central depression in the greater curvature of the middle gastric body. Colonoscopy revealed an ulcerative tumor extending from the splenic flexure to the mid transverse colon. Endoscopic biopsied specimens revealed adenosquamous cell carcinoma. From these findings, the diagnosis of PASC in the pancreatic tail invading into the stomach and transverse colon at an advanced stage IV was established. His anemia was treated by the administration of red blood cell concentration (RCC). Although chemotherapy was planned after his malnutrition improved, his circulatory condition worsened on day 20. Despite 10 units of RCC, his anemia did not improve and he died from circulatory insufficiency on day 23. An autopsy revealed PASC in the pancreas tail measuring 14 cm that had penetrated into the gastric wall and transverse colon. A massive amount of blood was discovered in the stomach. His death was caused by massive bleeding from the invaded lesions of the stomach. Adenosquamous carcinoma, consisting of adenocarcinoma and squamous cell carcinoma, is characterized by its aggressive proliferation and poor prognosis. To date, consensuses in the management of PASC have not been established. Further accumulation of knowledge about this carcinoma is required.

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“…Multidisciplinary treatments including aggressive surgery, intraoperative radiation therapy, and locoregional chemotherapy have also been reported to improve the survival of patients with adenosquamous carcinoma of the pancreas and to inhibit liver metastasis and local recurrence [12]. Shibagaki K et al presented a case of successful use of chemoradiotherapy with low-dose cispastin and additional combined chemotherapy with S-1 and cisplatin for unresectable pancreatic adenosquamous carcinoma [13]. Tanaka N et al suggested that combined chemotherapy with cytokines (IFN-a plus TNF-a) and 5-FU may be a therapeutic modality for advanced pancreatic cancer [14].…”

Section: Discussionmentioning

confidence: 99%

Adenosquamous carcinoma of the pancreas, a rare tumor entity: a case report

et al. 2009

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IntroductionAdenosquamous carcinoma of the pancreas is a rare variant of exocrine pancreatic tumor. This type of tumor is extremely rare as only few similar cases have been described in the literature.Case presentationWe present a case of a 72 years old male patient who was admitted to the hospital complaining of epigastric pain and jaundice. Pancreatic carcinoma of the head was diagnosed and a pylorus preserving pancreaticoduodenectomy was performed.ConclusionThis type of cancer is a very aggressive tumor followed by a dismisal prognosis. Multimodality therapy seems to be a reasonable approach but more studies are needed, to propose the most effective treatment.

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Complete response of a pancreatic adenosquamous carcinoma to chemoradiotherapy

Cited by 13 publications

References 19 publications

Resected pancreatic adenosquamous carcinoma: clinicopathologic review and evaluation of adjuvant chemotherapy and radiation in 38 patients

Resected pancreatic adenosquamous carcinoma: clinicopathologic review and evaluation of adjuvant chemotherapy and radiation in 38 patients

Adenosquamous Carcinoma of the Pancreas That Had Penetrated Into the Stomach and Transverse Colon: A Case Report

Adenosquamous carcinoma of the pancreas, a rare tumor entity: a case report

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