Pancreaticoduodenectomy after neoadjuvant chemotherapy for gastric cancer invading the pancreatic head: A case report

Figure 1 Initial endoscopic findings. A and B: Type 3 primary tumor located on the lower part of the stomach.

Figure 2 Initial computed tomography findings, computed tomography showed lymph node swelling. A: Swelling of #3 lymph node (LN) (orange triangle; 11.8 mm × 8.5 mm); B: Swelling of #4d LN (orange triangle; 10.3 mm × 8.4 mm); C: Swelling of #6 LN, suspected to be invasion to the pancreatic head (orange angle; 21.6 mm × 14.7 mm); D: Swelling of #8a LN (orange triangle; 14.0 mm × 13.4 mm).

Figure 3 Pathological findings from endoscopic biopsy. Pathological examination of the endoscopic biopsy revealed a papillary and well-differentiated adenocarcinoma. A: Hematoxylin and eosin staining results; × 10; B: Human epidermal growth factor receptor 2 positivity was detected by an immunohistochemical staining; × 10.

Figure 4 Pathological findings from resected specimens showing pancreatic infiltration of cancer cells. A: Hematoxylin and eosin staining results; × 4; B: Hematoxylin and eosin staining results; × 20.

Figure 5 Endoscopic findings after neoadjuvant chemotherapy. A and B Shrinkage of the primary tumor.

Figure 6 Computed tomography findings after neoadjuvant chemotherapy. A: #3 lymph node (LN) became smaller and could not be detected; B: #4d LN became smaller and could not be detected; C: #6 LN became smaller and could not be detected; D: #8a LN became smaller (orange triangle; 14.0 mm × 13.4 mm to 9.2 mm × 7.0 mm).