Figure legends
Figure 1: Computed tomography scan showing a 27-mm mass (arrow) and no major vessel involvement in the pancreatic head.
Figure 2: A, B) A whitish, solid, 50-mm mass (arrow) in the pancreatic head. C) Pathological findings showing cells with nuclear atypia including ductal and papillary structures. The lesion was diagnosed as a well-differentiated tubular adenocarcinoma.
Figure 3: A) Computed tomography scan showing growth of the mass at the bottom of the right lung. B) The cytological diagnosis was adenocarcinoma.
Figure 4: A) Pathological analysis showed an adenocarcinoma similar to the primary lesion, round-shaped enlarged nucleus, and mucin-producing columnar tumor cells proliferating in a tubular or papillary manner. B) Immunostaining is positive for CK7. C) Immunostaining is negative for CK20. D)Immunostaining is negative for TTF-1, indicating a low likelihood of primary lung cancer.
Figure 5: A) Magnetic resonance imaging showing a 23×22×20-mm neoplasm in the right inferior parietal lobule (arrow). B)Pathological findings showing a tumor similar to the primary lesion, cells with atypical nuclei, and a high N/C ratio, indicating papillary, fused ductal structures and solid arrangements, which are findings of adenocarcinoma.
Figure. 6) Tumor markers (CA19-9, CEA, DUPAN-2, and SPan1) were measured regularly during the course of the study; DUPAN-2 and SPan1 reflected disease activity.
Both decreased markedly after the PpPD, but not after pulmonary resection or after craniotomy, and decreased when chemotherapy was changed from GS to GEM + nab PTX.