Presentation
Abdominal pain and palpable mass on physical exam.
Patient Data
A 90×63×87 mm well defined low enhancing mass is noted at the pancreatic tail. The mass encases splenic vessels, and fat planes between the mass and adjacent stomach and left kidney seem obliterated.
Several peripancreatic and aortocaval enlarged lymph nodes are present with short axis diameter up to 18 mm.
There are multiple low enhancing masses in the liver up to 20 mm, inferring metastases.
Several non-enhancing simple cortical cysts and some parapelvic cysts are seen in both kidneys, with maximum diameters of 65 mm.
The prostate gland is enlarged.
Degenerative changes such as osteophytosis are seen in the lumbar spine.
Grade I spondylolisthesis of L4 on L5 is present.
Case Discussion
Large pancreatic mass; pathology proved ductal adenocarcinoma with splenic vessel encasement, regional and metastatic lymphadenopathy, suspected invasion into the adjacent stomach and left kidney, and hepatic metastases.