Presentation
Loss of weight, loss of appetite, on and off abdominal pain and rising serum Ca 19-9.
Patient Data
Atrophic tail of pancreas. Poorly enhancing large mass lesion is seen epicentered in body of pancreas associated with subcentimetric non enhancing areas within. It is causing splenic vein thrombosis, posteriorly extending beyond the margin of the gland, encasing 360 degrees the celiac axis and the origin of all its branches. Proximal SMA is also encased 270 degrees. There is direct infiltration of left adrenal gland and duodenojejunal flexure. Perilesional retroperitoneal subcentimetric lymph nodes seen.
No other solid visceral spread, no bony lesions or ascites.
Case Discussion
The most common hypoenhancing tumor of pancreas is the ductal adenocarcinoma. The encasement of celiac axis and SMA makes the tumor unresectable (stage T4). This case demonstrates the typical perineural and perivascular invasion of a pancreatic adenocarcinoma, making it one of the most lethal abdominal neoplasms.
Despite improvements in survival rates, currently, stage IV pancreatic ductal adenocarcinoma has a 5 year survival rate of <1%.
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