Infiltrative mesenteric desmoid tumor, main duct mucinous neoplasm of the pancreas
Presentation
Abdominal discomfort.
Patient Data
Moderate intrahepatic and common bile duct dilation to the ampulla.
Massive cystic dilation of the main pancreatic duct and sidebranches. No solid enhancing nodules. Stranding about uncinate process indicating component of pancreatitis. Small calcifications in the pancreatic tail.
Non-obstructive left renal stones.
Total colectomy with right upper quadrant ileostomy.
Extensively infiltrative mesenteric mass which extends into the right paracolic gutter.
Case Discussion
Very complex case. Classical finding of main duct mucinous neoplasm of the pancreas, which carries around a 65% risk of harboring carcinoma.
The key to understanding the mesenteric findings is noticing that this patient had a total colectomy, and then asking "why?".
At the time of this dictation, no additional history was given, therefore, this fact was (cruelly) withheld from the presentation. This patient underwent total colectomy many years prior for familial polyposis and resection of desmoid tumor in the 70's.
This is a great example of a more insidious appearance of intra-abdominal desmoid, which can have a mass-like, infiltrative, or combined appearance. FAP patients are at particularly notable risk after colectomy.
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