Different response of two primary neoplastic lesions to neoadjuvant therapy: a case report

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor, which is mostly solitary in the pancreas. Surgery-based comprehensive treatment with adjuvant chemotherapy is the currently advanced treatment modality, neoadjuvant chemotherapy has achieved satisfactory results, however, due to the high heterogeneity of PDAC, its sensitivity to chemotherapy is also different. A 66-year-old man presented with discomfort in the upper abdomen and Computed Tomography (CT) scans revealed two tumor lesions in the head and tail of the pancreas, respectively. Endoscopic ultrasonoraphy guided fine needle aspiration (EUS-FNA) was performed to clarify the pathology and the patient was recommended to undergo neoadjuvant therapy. Through five courses of neoadjuvant chemotherapy, the two tumors showed different treatment effects, and after evaluation, total pancreatectomy and splenectomy were provided to patients.We report a case of the one patient presenting with two pancreatic cancer lesions, who demonstrated different therapeutic responses after receiving neoadjuvant chemotherapy due to the heterogeneity of PDAC.