Pancreatic Ductal Adenocarcinoma with Medullary Features and a Complete Pathological Response After Neoadjuvant FOLFIRINOX: A Case Report and Literature Review

Purpose Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor response to chemotherapy. High-frequency microsatellite instability (MSI-H) is a rare biological phenomenon in conventional PDAC, being more frequently described in tumors with medullary or mucinous features. Metho...

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Bibliographic Details
Published in:Journal of gastrointestinal cancer 2025-12, Vol.56 (1), p.42, Article 42
Main Authors: Taboada, Rodrigo Gomes, Arruda Almeida, Maria Fernanda, Santiago, Karina Miranda, Carraro, Dirce Maria, Nunes, Warley Abreu, Diniz, Alessandro Landskron, Felismino, Tiago Cordeiro, de Jesus, Victor Hugo Fonseca
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Cancer Research
Carcinoma, Pancreatic Ductal - drug therapy
Carcinoma, Pancreatic Ductal - pathology
Case Report
Fluorouracil - therapeutic use
Gastroenterology
Humans
Internal Medicine
Irinotecan - therapeutic use
Leucovorin - therapeutic use
Male
Medicine
Medicine & Public Health
Microsatellite Instability
Middle Aged
Neoadjuvant Therapy - methods
Oncology
Oxaliplatin - therapeutic use
Pancreatic Neoplasms - drug therapy
Pancreatic Neoplasms - pathology
Radiotherapy
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Summary:Purpose Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor response to chemotherapy. High-frequency microsatellite instability (MSI-H) is a rare biological phenomenon in conventional PDAC, being more frequently described in tumors with medullary or mucinous features. Methods and Results In this manuscript, we report the case of a patient with an MSI-H pancreatic carcinoma with medullary features (medullary carcinoma of the pancreas—MCP) that achieved a complete pathological response after neoadjuvant modified FOLFIRINOX. Additionally, we summarize the available evidence on the clinical, pathological, and molecular features of patients with MCP, along with survival outcomes. Conclusions MCPs present significant sensitivity not only to immune checkpoint inhibitors, but also to systemic chemotherapy and that the latter treatment modality should not be overlooked. They also present different pathological and molecular features compared with conventional PDAC, meaning they should be considered a separate pathological entity.
ISSN:1941-6628
1941-6636
1941-6636
DOI:10.1007/s12029-024-01140-5