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<p>A woman in her 70&#xa0;s presenting with epigastric pain was referred to our hospital. Contrast-enhanced computed tomography revealed a large tumor adjacent to the superior mesenteric vein. Upper gastrointestinal endoscopy identified a submucosal tumor in the antrum. Endoscopic ultrasonography indicated that the tumor was 50&#xa0;mm in size, characterized by a well-demarcated, round, solid mass with homogeneous components. Fine needle biopsy confirmed adenocarcinoma, leading to a preoperative diagnosis of gastric cancer with a submucosal tumor-like appearance. Staging laparoscopy was conducted, revealing the tumor to be localized around the antrum, compressing the pancreatic head parenchyma. A solitary 1&#xa0;cm dissemination in the omentum was resected. Six months of chemotherapy with S1 and oxaliplatin led to a significant reduction in tumor size. Distal gastrectomy with partial pancreatectomy was performed as a conversion surgery. Pathological examination revealed poorly differentiated pancreatic adenocarcinoma, and additional genetic test confirmed high microsatellite instability. Adjuvant chemotherapy with S1 was administered for an additional six months. Two years and three months after the surgery, the patient developed hemiplegia. Magnetic resonance imaging revealed a 6&#xa0;cm, irregularly shaped tumor in the left occipital lobe, which was surgically excised. Pathological analysis confirmed metastasis from the pancreatic cancer. Due to a poor performance status post-surgery, the patient was unable to receive pembrolizumab after the disease relapse three months following the brain surgery. The patient succumbed to systemic tumor progression four months after the onset of hemiplegia.</p>

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A case of pancreatic cancer with high microsatellite instability exhibiting rare clinical features

  • 期刊论文

  • 发表日期：

    2025年12月9日

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  • Yukiko Suzuki,
  • Hirohisa Okabe,
  • Hiromitsu Hayashi,
  • Teruki Sako,
  • Yuki Hisano,
  • Takumi Tanizaki,
  • Yoshiyuki Tagayasu,
  • Kosuke Kanemitsu,
  • Yuki Adachi,
  • Takuya Tajiri,
  • Shinsei Yumoto,
  • Daisuke Ogawa,
  • Rumi Itoyama,
  • Yuki Kitano,
  • Kojiro Eto,
  • Shigeki Nakagawa,
  • Masaaki Iwatsuki

摘要

A woman in her 70 s presenting with epigastric pain was referred to our hospital. Contrast-enhanced computed tomography revealed a large tumor adjacent to the superior mesenteric vein. Upper gastrointestinal endoscopy identified a submucosal tumor in the antrum. Endoscopic ultrasonography indicated that the tumor was 50 mm in size, characterized by a well-demarcated, round, solid mass with homogeneous components. Fine needle biopsy confirmed adenocarcinoma, leading to a preoperative diagnosis of gastric cancer with a submucosal tumor-like appearance. Staging laparoscopy was conducted, revealing the tumor to be localized around the antrum, compressing the pancreatic head parenchyma. A solitary 1 cm dissemination in the omentum was resected. Six months of chemotherapy with S1 and oxaliplatin led to a significant reduction in tumor size. Distal gastrectomy with partial pancreatectomy was performed as a conversion surgery. Pathological examination revealed poorly differentiated pancreatic adenocarcinoma, and additional genetic test confirmed high microsatellite instability. Adjuvant chemotherapy with S1 was administered for an additional six months. Two years and three months after the surgery, the patient developed hemiplegia. Magnetic resonance imaging revealed a 6 cm, irregularly shaped tumor in the left occipital lobe, which was surgically excised. Pathological analysis confirmed metastasis from the pancreatic cancer. Due to a poor performance status post-surgery, the patient was unable to receive pembrolizumab after the disease relapse three months following the brain surgery. The patient succumbed to systemic tumor progression four months after the onset of hemiplegia.