Pancreatic undifferentiated carcinoma with osteoclast-like giant cells curatively resected after pembrolizumab therapy for lung metastases: a case report
Abstract Background Therapy targeting programmed death-1 or programmed death-1 ligand-1 (PD-1/PD-L1) has been developed for various solid malignant tumors, such as melanoma and non-small-cell lung cancer (NSCLC), but this approach has little effect in the treatment of pancreatic cancer. Pancreatic u...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-07-01
|
| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12876-020-01362-4 |
| _version_ | 1818249398867460096 |
|---|---|
| author | Miku Obayashi Yasushi Shibasaki Toru Koakutsu Yoshiro Hayashi Tsuyoshi Shoji Kazuhisa Hirayama Masanori Yamazaki Yasuhiro Takayanagi Hiroshi Shibata Masato Nakamura Hirotoshi Maruo |
| author_facet | Miku Obayashi Yasushi Shibasaki Toru Koakutsu Yoshiro Hayashi Tsuyoshi Shoji Kazuhisa Hirayama Masanori Yamazaki Yasuhiro Takayanagi Hiroshi Shibata Masato Nakamura Hirotoshi Maruo |
| author_sort | Miku Obayashi |
| collection | DOAJ |
| description | Abstract Background Therapy targeting programmed death-1 or programmed death-1 ligand-1 (PD-1/PD-L1) has been developed for various solid malignant tumors, such as melanoma and non-small-cell lung cancer (NSCLC), but this approach has little effect in the treatment of pancreatic cancer. Pancreatic undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) is a rare pancreatic malignancy having unique morphology and is considered a variant of pancreatic ductal adenocarcinoma (PDAC). Although UCOGC has been reported to have better prognosis than conventional PDAC, the optimal treatment for UCOGC with distant metastases has not been determined. Case presentation A 66-year-old man was initially diagnosed with NSCLC with multiple intrapulmonary metastases and abdominal lymph node metastasis in the tail of the pancreas, and bronchial biopsy and diagnostic imaging were performed. Pathologic examination of the lung showed poorly differentiated adenocarcinoma cells expressing epithelial marker and PD-L1. Therefore, pembrolizumab monotherapy for NSCLC was given. The pulmonary lesions shrank markedly and were in complete remission after 8 months of anti-PD-1 therapy, though no therapeutic effect was observed in the pancreatic site. Distal pancreatectomy was then performed, and histopathological examination showed that the tumor was UCOGC originating from the pancreas. The histologic findings of the resected specimen mimicked those of the lung biopsy specimen, leading to the final assessment that the lung tumors were metastatic foci that migrated from the UCOGC, and only the metastatic lesions benefited from pembrolizumab therapy. Conclusion Immune checkpoint inhibitors have limited therapeutic effects on primary lesions of pancreatic cancer, but they may exert antitumor effects on pulmonary metastases of UCOGC. |
| first_indexed | 2024-12-12T15:35:52Z |
| format | Article |
| id | doaj.art-3a77ced20ce54a318496e1ad7c31944c |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-12T15:35:52Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-3a77ced20ce54a318496e1ad7c31944c2022-12-22T00:20:00ZengBMCBMC Gastroenterology1471-230X2020-07-012011710.1186/s12876-020-01362-4Pancreatic undifferentiated carcinoma with osteoclast-like giant cells curatively resected after pembrolizumab therapy for lung metastases: a case reportMiku Obayashi0Yasushi Shibasaki1Toru Koakutsu2Yoshiro Hayashi3Tsuyoshi Shoji4Kazuhisa Hirayama5Masanori Yamazaki6Yasuhiro Takayanagi7Hiroshi Shibata8Masato Nakamura9Hirotoshi Maruo10Department of Surgery, Shizuoka City Shimizu HospitalDepartment of Surgery, Shizuoka City Shimizu HospitalDepartment of Surgery, Shizuoka City Shimizu HospitalDepartment of Surgery, Shizuoka City Shimizu HospitalDepartment of Surgery, Shizuoka City Shimizu HospitalDepartment of Surgery, Shizuoka City Shimizu HospitalDepartment of Surgery, Shizuoka City Shimizu HospitalDepartment of Gastroenterology, Shizuoka City Shimizu HospitalDepartment of Respiratory Medicine, Shizuoka City Shimizu HospitalDepartment of Pathology, Shizuoka City Shimizu HospitalDepartment of Surgery, Shizuoka City Shimizu HospitalAbstract Background Therapy targeting programmed death-1 or programmed death-1 ligand-1 (PD-1/PD-L1) has been developed for various solid malignant tumors, such as melanoma and non-small-cell lung cancer (NSCLC), but this approach has little effect in the treatment of pancreatic cancer. Pancreatic undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) is a rare pancreatic malignancy having unique morphology and is considered a variant of pancreatic ductal adenocarcinoma (PDAC). Although UCOGC has been reported to have better prognosis than conventional PDAC, the optimal treatment for UCOGC with distant metastases has not been determined. Case presentation A 66-year-old man was initially diagnosed with NSCLC with multiple intrapulmonary metastases and abdominal lymph node metastasis in the tail of the pancreas, and bronchial biopsy and diagnostic imaging were performed. Pathologic examination of the lung showed poorly differentiated adenocarcinoma cells expressing epithelial marker and PD-L1. Therefore, pembrolizumab monotherapy for NSCLC was given. The pulmonary lesions shrank markedly and were in complete remission after 8 months of anti-PD-1 therapy, though no therapeutic effect was observed in the pancreatic site. Distal pancreatectomy was then performed, and histopathological examination showed that the tumor was UCOGC originating from the pancreas. The histologic findings of the resected specimen mimicked those of the lung biopsy specimen, leading to the final assessment that the lung tumors were metastatic foci that migrated from the UCOGC, and only the metastatic lesions benefited from pembrolizumab therapy. Conclusion Immune checkpoint inhibitors have limited therapeutic effects on primary lesions of pancreatic cancer, but they may exert antitumor effects on pulmonary metastases of UCOGC.http://link.springer.com/article/10.1186/s12876-020-01362-4Undifferentiated carcinoma with osteoclast-like giant cellsUCOGCPancreatic ductal adenocarcinomaLung metastasisPembrolizumabPD-1 |
| spellingShingle | Miku Obayashi Yasushi Shibasaki Toru Koakutsu Yoshiro Hayashi Tsuyoshi Shoji Kazuhisa Hirayama Masanori Yamazaki Yasuhiro Takayanagi Hiroshi Shibata Masato Nakamura Hirotoshi Maruo Pancreatic undifferentiated carcinoma with osteoclast-like giant cells curatively resected after pembrolizumab therapy for lung metastases: a case report BMC Gastroenterology Undifferentiated carcinoma with osteoclast-like giant cells UCOGC Pancreatic ductal adenocarcinoma Lung metastasis Pembrolizumab PD-1 |
| title | Pancreatic undifferentiated carcinoma with osteoclast-like giant cells curatively resected after pembrolizumab therapy for lung metastases: a case report |
| title_full | Pancreatic undifferentiated carcinoma with osteoclast-like giant cells curatively resected after pembrolizumab therapy for lung metastases: a case report |
| title_fullStr | Pancreatic undifferentiated carcinoma with osteoclast-like giant cells curatively resected after pembrolizumab therapy for lung metastases: a case report |
| title_full_unstemmed | Pancreatic undifferentiated carcinoma with osteoclast-like giant cells curatively resected after pembrolizumab therapy for lung metastases: a case report |
| title_short | Pancreatic undifferentiated carcinoma with osteoclast-like giant cells curatively resected after pembrolizumab therapy for lung metastases: a case report |
| title_sort | pancreatic undifferentiated carcinoma with osteoclast like giant cells curatively resected after pembrolizumab therapy for lung metastases a case report |
| topic | Undifferentiated carcinoma with osteoclast-like giant cells UCOGC Pancreatic ductal adenocarcinoma Lung metastasis Pembrolizumab PD-1 |
| url | http://link.springer.com/article/10.1186/s12876-020-01362-4 |
| work_keys_str_mv | AT mikuobayashi pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT yasushishibasaki pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT torukoakutsu pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT yoshirohayashi pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT tsuyoshishoji pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT kazuhisahirayama pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT masanoriyamazaki pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT yasuhirotakayanagi pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT hiroshishibata pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT masatonakamura pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport AT hirotoshimaruo pancreaticundifferentiatedcarcinomawithosteoclastlikegiantcellscurativelyresectedafterpembrolizumabtherapyforlungmetastasesacasereport |