Squamous Cell Carcinoma of the Pancreas, a Treatment Dilemma: Case Report and Review of Literature

Abstract

Primary squamous cell carcinoma (SCC) of the pancreas is rare and little is known about its risk factors, course, and response to chemotherapy. However, it has been shown to have worse survival rates than adenocarcinoma. The median survival of non-resectable SCC of the pancreas is 3 months. This is in part due to the absence of clear guidelines on its management, and oncologists often resort to case reports for management of the disease. A 59-year-old male patient presented with chronic abdominal pain, generalized back pain and fatigue. Imaging revealed a left upper quadrant mass arising from the pancreatic tail, with innumerable liver metastases. Pathologic exam of the liver lesions confirmed the diagnosis of metastatic poorly differentiated SCC of pancreatic origin. The incidence of Squamous cell cancer of the pancreas ranges between 0.05- 5%. As pancreatic SCC is a diagnosis of exclusion, other primary SCC sources must be ruled out. Differentiating features between adenocarcinoma and SCC include: enhancement of tumor on contrast CT + increased attenuation with contrast, and tumor blush pattern on angiography. EUS- guided biopsy has a sensitivity of 90% and specificity of 96%, and remains the diagnostic gold standard. In our patient, further workup did not detect any other primary sources. We concluded that this was a case of primary SCC of the pancreas. Pancreatic SCC poses a treatment challenge. There are no specific management algorithms demonstrating superiority of any specific chemotherapeutic regimen. Pancreatic adenocarcinoma therapy guidelines are usually followed for its treatment. Some physicians resort to case reports with experimental therapies, with some papers suggestig supperior results over the conventional Adenocarcinoma treatment. We believe it is important that further studies be conducted for pancreatic SCC specific therapies.FigureFigure: Liver core biopsy replaced by carcinoma producing nests with necrosis and focal keratinization.Figure. 6: 9 x 6.6 x 5.8 cm left upper quadrant enhancing lobular hypoattenuating mass appears to arise from the pancreatic tail with evidence of metastatic disease to the liver.