Long-Term Survival by Resection and Adjuvant Chemotherapy With S-1 in Pancreatic Signet Ring Cell Carcinoma: a Case Report With Literature Review

Abstract

Background: Signet ring cell carcinoma (SRCC) of the pancreas is a very rare histologic variant of pancreatic carcinoma with very poor prognosis. We present a case of pancreatic SRCC with good prognosis achieved by resection and adjuvant chemotherapy with S-1 one year, which is the standard treatment for advanced resected gastric cancer in Japan. The stomach carried a higher incidence of SRCC than other sites.Case presentation: A 70-year-old man presented with abdominal discomfort, and ultrasonography revealed a mass in the pancreas. Computed tomography showed a hypovascular tumor in the head of the pancreas, 51 mm in diameter, with invasion to the portal vein and duodenum. The patient underwent pancreaticoduodenectomy (PD) with portal vein resection and reconstruction. The pathological diagnosis was SRCC of the pancreas without invasion to the portal vein, pT3N1M0 Stage IIB (UICC classification). Subsequently, postoperative adjuvant chemotherapy with S-1 was initiated to prevent recurrence. The patient has remained recurrence-free for 2 years and 6 months after PD. Conclusion: Adjuvant chemotherapy with S-1 may be an important factor for improving the prognosis of patients with resectable SRCC of the pancreas.