Pancreatic carcinosarcoma: a rare type of pancreatic neoplasia with long-term survival

A woman in her 60s presented with persistent abdominal pain and jaundice. She had a history of BRCA1 gene mutation and was previously treated for triple-negative early breast cancer. Abdominal ultrasound and CT scan of the abdomen revealed a mass around the pancreatic head. Magnetic resonance cholangiopancreatography showed a dilated common bile duct and a normal pancreatic duct. Liver function improved after endoscopic retrograde cholangiopancreatography and biliary stent placement. Staging CT confirmed no distant metastasis. The patient underwent Whipple's procedure to remove the pancreatic lesion. Histology from the resection confirmed carcinosarcoma with positive margins, along with lymphovascular, perineural and nodal involvement. She was offered adjuvant chemotherapy with a combination of Folinic acid, 5-fluorouracil, Oxaliplatin and Irinotecan (FOLFIRINOX). Due to derangement in liver enzymes after one cycle of chemotherapy, an MRI scan confirmed liver metastasis. The same chemotherapy regimen was continued in a palliative setting, initially showing a partial response to the liver metastases, but subsequently resulting in a long-term complete radiological response. Pancreatic carcinosarcoma is a rare type of cancer with no clear consensus on the appropriate management. In this case, FOLFIRINOX palliative chemotherapy led to long-term disease control. Future studies on molecular profiling may provide insights for genotype-driven, personalised treatment strategies for similar cases.