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Pancreatic cancer - T4 - uncinate process

Case contributed by: Dr Natalie Yang

Patient Data:

Age: Adult

From the case: Pancreatic cancer - T4 - uncinate process

Modality: CT

C+ portal venous phase

A large heterogeneous mass arising from the head of the pancreas is present which abuts the superior mesenteric artery over more than 180 degrees and results in narrowing. The upper aspect of the superior mesenteric vein and origin of the main portal vein are also stenosed. A biliary stent is in situ with associated pneumobilia. The main pancreatic duct is markedly dilated and pancreatic parenchyma atrophic. Numerous enlarged retroperitoneal nodes are present.

Case Discussion:

This case illustrates T4 pancreatic cancer. The vascular criteria for unresectability varies from country to country and surgeon to surgeon, but generally it is accepted that SMA with tumour encasement >180 degrees circumference (which this case has, with associated narrowing) is unresectable. A coronal would probably be better to demonstrate it. The portal vein at the origin is very narrow... combined with the SMA involvement would make it unresectable.

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