A Highly Responsive Pancreatic Ductal Adenocarcinoma with Liver Metastasis: A Rare Case Report

Figures & data

Figure 1 The result of CT-abdomen on March 11, 2019. (A) The invasion of SMA; (B) the metastasis of right liver; (C) the invasion of GDA and SMA; (D) the invasion of SMA; (E) the invasion of PV; (F) the invasion of SMV.

Abbreviations: GDA, gastroduodenal artery; SMA, superior mesenteric artery; SMV, superior mesenteric vein; PV, portal vein; CT, computed tomography.

Figure 2 The histopathological result of percutaneous biopsy guided by CT. (A) 4×10 magnification; (B) 10×10 magnification; (C) 20×10 magnification.

Figure 3 The X-ray image during TACE.

Abbreviation: TACE, transarterial chemoembolization.

Figure 4 The result of CT-abdomen during the process of treatment. (A and D) The CT-abdomen result on April 15, 2019; (B and E) The CT-abdomen result on May 10, 2019; (C and F) The CT-abdomen result on July 26, 2019.

Figure 5 Changes of the tumor diameter and the main laboratory blood tests of this patient. (A) changes of the primary tumor; (B) changes of the liver metastasis; (C) changes of the CEA level; (D) changes of the CA125 level.

Abbreviation: PDCA, pancreatic ductal adenocarcinoma; CEA, carcinoembryonic antigen; CA125, carbohydrate antigen 125.

Figure 6 The postoperative specimen and histopathological result. (A) Postoperative specimen; (B) 4×10 magnification; (C) 10×10 magnification; (D) 20×10 magnification.

Table 1 Main Laboratory Test Results

Items	Normal Range	2019/3/13	2019/4/15	2019/05/10	2019/7/29	2019/09/04	2019/12/11	2020/03/23	2020/7/1	2020/10/14
Routine blood test
WBC count (×10^9/L)	3.50–9.50	7.33	5.70	4.78	4.79	8.47	5.08	5.57	3.90	4.97
RBC count (×10^12/L)	3.80–5.10	3.21	3.53	3.68	3.56	3.25	3.95	3.98	3.46	3.35
Hb (g/L)	115.0–150.0	70	91	108.0	120.0	107	118	125	107.0	102
PLT count (×10^9/L)	125–350	410	270	333	250	320	312	378	264	389
Biochemical test
TB (μmol/L)	5.0–17.1	16.7	15.6	13.5	16.4	33.6	18.8	19.7	28.4	14.3
DB (μmol/L)	0–6.0	5.2	5.1	2.1	2.8	11.7	3.1	3.2	4.5	2.6
Albumin (g/L)	35.0–55.0	33.8	37.0	39.4	40.5	39.1	39.9	47.6	42.4	40.4
ALT (U/L)	7–40	37	12	17	24	122	39	43	40	44
AST (U/L)	13–35	32	17	19	23	126	31	29	39	41
γ-GT (U/L)	7–45	173	48	33	29	261	86	80	48	90
Tumor biomarkers
CEA (ng/ml)	0–5.00	941.60	220.50	48.79	2.74		1.41	3.92	2.11	1.17
CA-125 (U/ml)	0–30.20	271.60	55.94	25.18	21.65		18.00	13.20	14.30	11.70
CA-199 (U/ml)	0–37.00	15.83	21.78	19.45	17.08		30.38	29.23	22.25	25.94
AFP (ng/ml)	0–8.10	1.16	2.63	2.63	5.96		1.3	4.90	5.60	1.60

Note: The result with the blue mark means it is lower than normal range, while the result with the red mark means it is higher than normal range.

Abbreviations: γ-GT, γ-glutamyl transferase; AFP, alpha-fetoprotein; ALT, glutamate pyruvate transaminase; AST, glutamic oxaloacetic transaminase; CEA, carcinoembryonic antigen; CA, carbohydrate antigen; DB, direct bilirubin; Hb, hemoglobin; PLT, platelet; RBC, red blood cell; TB, total bilirubin; WBC, white blood cell.

Figure 7 The result of CT-abdomen after operation. There is no sign of recurrence of metastasis. (A and D) The CT-abdomen result on September 4, 2019; (B and E) the CT-abdomen result on March 23, 2020; (C and F) the CT-abdomen result on October 10, 2020.

Figure 8 The flow chart of multidisciplinary treatment.