Metastatic adenocarcinoma of the pancreas tail with colon obstruction

Case contributed by Dr Michael P Hartung

Presentation

Abdominal distension, concern for obstruction.

Patient Data

Age: 70 years
Gender: Male

Lobulated heterogeneous mass in the pancreatic tail growing into and obstructing the colon at the splenic flexure. Mass also invades the left renal vein and upper pole calyx, resulting in delayed left nephrogram. Splenic vein is also obstructed with short gastric varices. Numerous metastases throughout the left hepatic lobe. Possible small pulmonary embolus in a subsegmental right lower lobe artery (first image). Small nodules in the imaged lower lobes are worrisome for metastases. 

Case Discussion

FINAL DIAGNOSIS:
Liver, mass, CT-guided needle core biopsy - Adenocarcinoma, consistent with pancreatic primary.

A later presentation of pancreatic adenocarcinoma given the location of the tumor within the pancreatic tail. When the primary is in the pancreatic head, the patient may present early with jaundice or pancreatitis. However, in this case, the patient presents with colonic obstruction. There is also obstruction of the splenic vein with short gastric varices, obstruction of the left renal vein and upper pole calyx with delayed left nephrogram, and extensive metastases within the left hepatic lobe.

 

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