[Complete Response of Adrenal Metastasis from Pancreatic Cancer Achieved by Multimodal Therapy-A Case Report]

A male in his 60s who presented for evaluation of markedly elevated serum CA19-9 levels. Imaging studies revealed a carcinoma located in the pancreatic tail. He was diagnosed with resectable pancreatic tail cancer(Pt, TS2[35 mm], T3, S1, RP1, PV1[PVsp], A1[Asp], PL0, OO1[gastric invasion], N0, M0 cStage ⅡA). Neoadjuvant chemotherapy with gemcitabine +S-1 was administered, resulting in a partial response according to RECIST criteria. The patient subsequently underwent distal pancreatectomy, local gastrectomy, and partial left adrenalectomy. Histopathological examination confirmed pancreatic tail carcinoma:Pt, well-differentiated, TS2(30 mm), ypT3, ypS1, ypRP1, ypPV0, ypA0, ypPL1(PLspa), ypOO1(gastric invasion), ypN1a, M0, ypStage ⅡB, R0 resection, Grade 1b. Notably, there was no evidence of direct adrenal invasion. Postoperative adjuvant chemotherapy with S-1 was administered. One year after surgery, contrast-enhanced CT and PET-CT revealed enlargement of the left adrenal gland with abnormal FDG uptake(SUVmax 6.5). EUS-FNA confirmed adrenal metastasis from pancreatic cancer. The patient underwent chemoradiotherapy consisting of 60 Gy in 30 fractions combined with gemcitabine+nab-paclitaxel. Serum CA19-9 normalized, and FDG uptake on PET-CT resolved. Subsequently, a left adrenalectomy was performed. Histopathological evaluation revealed no viable cancer cells, showing only post-treatment changes, consistent with a pathological complete response(Grade 4). The postoperative course was uneventful, and at 6 months post-adrenalectomy, the patient remains recurrence-free without further adjuvant therapy.