S1554 Unusual Mutation in Squamous Cell Carcinoma of Pancreas

Abstract

INTRODUCTION: Pancreatic neoplasm is an aggressive malignant tumor of the digestive tract and a leading cause of death related worldwide. Squamous cell carcinoma of pancreas (SCCP) currently has an annual incidence rate of 0.02 cases per 100,000. The diagnosis is made only after excluding other neoplastic lesions of the pancreas that contain squamous epithelial components. CASE DESCRIPTION/METHODS: A 72 years old male with a history of diabetes mellitus, hypertension and a resected colorectal cancer that three years after resection, developed fatigue, unintentional weight loss, asthenia and anorexia. A contrast Abdominal CT revealed hepatomegaly suggestive of metastatic disease, intrahepatic and extrahepatic biliary duct dilation, and a pancreatic tail mass. CT guided biopsy of liver lesion showed metastatic squamous cells. PET scan identified a hypermetabolic, 3cm soft tissue mass in the left upper quadrant of the abdomen inseparable from the tail of the pancreas. Endoscopic ultrasound fine needle aspiration revealed a moderately differentiated SCCP. Next-generation sequencing came out with six genomic mutations, KRAS, FGFR1, NKX2-1, PBRM1, SPEN, and TP53. The patient was admitted to an oncologic unit where Nanoparticle albumin-bound paclitaxel-gemcitabine regimen was administered. However, due to complications including sepsis, and multi-organ failure, therapy was discontinued. Unfortunately, the patient succumbed to the latter. DISCUSSION: SCCP is a rare entity as squamous cells are naturally absent from the pancreas. However, these can be seen in conditions such as chronic pancreatitis, primary or metastatic carcinoma, and squamous metaplasia related to pancreatic or biliary duct stent placement. Squamous tumours are enriched for TP53 and KDM6A mutations, upregulation of the TP63 transcriptional network, hypermethylation of pancreatic endodermal cell-fate determining genes and have a poor prognosis. Thus, identifying patients who are at high risk to develop pancreatic cancer and who should undergo surveillance has to be a priority. In addition, there is a need to develop tumor markers for early detection, monitoring and treatment purposes. Precursor lesions might represent the opportunity to cure pancreatic neoplasia. With the integration of high throughput sequencing to the clinical practice, valuable information will be obtained. Consequently, providing better understanding of its pathogenesis, improving therapies alternatives and outcomes of pancreatic carcinomas.Figure 1.: Pancreas moderately differentiated Squamous Cell Carcinoma.Figure 2.: Multiple, hypermetabolic, large hepatic lesions, and a 3 cm soft mass in the left upper quadrant, inferior to the stomach and anterior to the spleen inseparable from the tails of pancreas.