Locally advanced pancreatic cancer

Case contributed by Stefan Tigges
Diagnosis almost certain


Evaluate known pancreatic cancer.

Patient Data

Age: 50 years
Gender: Male

Locally advanced pancreatic mass at the head, neck and proximal body. Infiltration of the retroperitoneum and extension into the root of mesentery with encasement of the celiac axis and SMA with associated narrowing. Encasement of main portal, superior mesenteric and splenic venous confluence with peripancreatic cavernous transformation extending to the hepatic hilum. Right and left portal veins are patent. Mass abuts the abdominal aorta near the origin of celiac artery as well as IVC near the confluence with the left renal vein. Marked atrophy of the upstream pancreatic body/tail with mild ductal dilatation. Small loculated collection superior to the pancreatic neck.

Subcentimeter mesenteric and portacaval lymph nodes.

Small-volume ascites with mild central mesenteric edema and trace fluid in the right paraduodenal region. 10 x 8 mm soft tissue nodule along the left anterior pararenal fascia.

Case Discussion

Good example of locally advanced pancreatic cancer with encasement celiac axis/SMA making this a T4 tumor. The vessel encasement is well shown in the coronal and sagittal planes.

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