Head of pancreas mass with invasion of the superior mesenteric artery

Case contributed by Dr Kenny Sim

Presentation

Obstructive jaundice and 10kg of weight loss.

Patient Data

Age: 75
Gender: Male

There is a large, hypoenhancing head of pancreas tumour that measures 2.6 x 4.4 x 4.6 cm. The tumour extends into the uncinate process as well as invading the base of the small bowel mesentery, and jejunal vessels. The tumour also incompletely encases the superior mesenteric artery. The portal, splenic and superior mesenteric veins opacify normally. The common bile duct is dilated up to 15 mm and there is also presence of intrahepatic duct dilatation. The main pancreatic duct is also dilated to 6 mm.

Within segment 3 of the liver, there is a rounded 6 mm hypodensity that demonstrates fluid attenuation and likely represents a liver cyst. No other focal liver lesions identified. Multiple bilateral rounded hypodensities in the kidneys are also in keeping with simple renal cysts. A larger more irregular shaped 22 mm lesion within the midpole left kidney does not demonstrate enhancement and is likely a collapsed haemorrhagic cyst. Bilateral adrenal glands, spleen and imaged portion of the bowel have an unremarkable appearance. Small hiatus hernia. There are multiple subcentimetre azygo-oesophageal, coeliac axis, left gastric, para-aortic and mesenteric lymph nodes. No peritoneal metastases identified.

Conclusion:

Large head of pancreas tumour that invades the superior mesenteric artery, small bowel mesentery and jejunal vessels. The tumour causes obstruction of the common bile duct and main pancreatic duct. Although no definite evidence of metastatic disease, there are multiple subcentimetre posterior mediastinal, coeliac trunk, para-aortic and mesenteric lymph nodes.

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Case information

rID: 30413
Case created: 8th Aug 2014
Last edited: 6th Oct 2015
Inclusion in quiz mode: Included

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