Late-stage hepatoid adenocarcinoma of the pancreatic head with a long survival after surgery: a case report.

[BACKGROUND] Hepatoid adenocarcinoma of the pancreas is a rare primary malignant tumor. According to few previous reports, with poor prognosis and atypical clinical features, hepatoid adenocarcinoma of the pancreas is easily misdiagnosed. Its pathological examination often shows similar morphological and immunohistochemical features to those of hepatocellular carcinoma. There is also insufficient clinical experience in the diagnosis and treatment of hepatoid adenocarcinoma.

[CASE PRESENTATION] A 45-year-old Asian woman, initially suspected to have late-stage pancreatic ductal adenocarcinoma, was admitted to our clinic with abdominal pain and jaundice. The magnetic resonance imaging scan showed a pancreatic head mass with enlarged retroperitoneal and portal lymph nodes. To confirm the diagnosis, a thorough evaluation of her medical history, clinical presentation, imaging findings, and laboratory tests was conducted. An endoscopic ultrasound-guided biopsy was performed, and the initial biopsy report suggested a neuroendocrine tumor. Based on this finding, a multidisciplinary team discussion was held, and the decision was made to proceed with radical surgery. Postoperative pathological examination unexpectedly revealed hepatoid adenocarcinoma of the pancreas, which led to a revision of the final clinical diagnosis. Following surgery, she received three cycles of postoperative adjuvant chemotherapy with a regimen of gemcitabine plus albumin-bound paclitaxel. Postoperative follow-up at 4 months indicated liver metastasis, for which she underwent microwave ablation. Subsequently, she was supplemented with adjuvant therapy combining durvalumab and S-1. At the time of writing, 16 months after her initial clinic visit, the patient remains alive without evidence of abdominal metastasis.

[CONCLUSION] This case of hepatoid adenocarcinoma of the pancreas achieved a better prognosis through a comprehensive treatment based on surgery after multidisciplinary team discussion, giving the patient hope for long-term survival. The multidisciplinary team, in the form of multidisciplinary experts coming together to discuss the patient's condition, changed the patient's treatment decision, which may be another option when it comes to complex cases.