Presentation
Abdominal pain for three months. Elevated ESR, CRP and CA19-9 on a recent blood test.
Patient Data
A 50×38 mm low-enhancing mass is noted in the pancreatic body that encases the celiac trunk, proximal of splenic and common hepatic arteries, SMA, SMV and portal confluence. Multiple dilated collateral vessels are seen in the porta hepatis, inferring cavernous transformation of the portal vein. In addition, some collateral vessels are seen in the perigastric regions.
The pancreatic duct distal to the mass is dilated. Peripancreatic fat stranding and a few regional enlarged lymph nodes with SAD less than 12 mm are also seen.
A 10 mm small non-enhanced cyst is noted in the segment IVa of the liver.
The spleen is enlarged, and its cephalocaudal height measured 150 mm.
An 8 mm stone is noted in the urinary bladder.
Case Discussion
Biopsy-proven pancreatic ductal adenocarcinoma with vascular encasement and involvement that causes cavernous transformation of the portal vein and splenomegaly, indicates an unresectable mass.
Celiac trunk and SMA tumor encasement and unreconstructible SMV/Portal vein due to tumor invasion or thrombosis are the main criteria for pancreatic ductal adenocarcinoma unresectability.