Patient Case Introduction

Metastatic Pancreatic Adenocarcinoma Case Summary

This case presents a male patient aged 82 years who sought medical attention from his primary care physician due to concerning symptoms of unexplained weight loss and abdominal pain. The patient experienced a significant weight reduction of more than 20 lb within a few months, prompting further clinical investigation. His medical history was notable for hyperlipidemia and hypertension, but he had no previous diagnosis of diabetes, baseline neuropathy, or family history of cancer. Despite his advanced age, the patient maintained an excellent performance status with an ECOG status of 0, indicating full activity without restrictions.

Comprehensive diagnostic workup revealed the presence of metastatic pancreatic adenocarcinoma. Imaging studies, including CT scans and MRI, identified a hypodense mass at the pancreatic tail along with peritoneal lesions, confirming metastatic spread. Laboratory findings showed an elevated white blood cell count (12,600) with an absolute neutrophil count of 9600, hemoglobin A_1C of 13.0, and normal platelet levels. The tumor marker CA 19-9 was significantly elevated at 857, which is consistent with pancreatic malignancy. A peritoneal biopsy was performed to obtain tissue confirmation, with pathology results definitively establishing the diagnosis of metastatic pancreatic adenocarcinoma.

Molecular profiling through NGS testing revealed important genetic alterations that would inform treatment decisions. The tumor harbored a KRAS G12D mutation and a TP53 mutation, both commonly found in pancreatic adenocarcinoma and associated with aggressive disease behavior. Additionally, comprehensive genetic testing was conducted to evaluate for hereditary cancer syndromes, which returned negative for pathogenic mutations. This molecular characterization provides crucial information for understanding the tumor biology and selecting appropriate therapeutic approaches for this patient with good functional status and metastatic disease.