Presentation
Abdominal pain.
Patient Data
95 × 70 mm heterogeneous enhancing mass at the pancreatic body and tail that encases splenic vessels. The mass is in close contact with the gastric body, left adrenal gland, and inferomedial aspect of the spleen, but fat planes seem to be preserved. Suspected invasion into the adjacent transverse colon, which shows focal wall thickening.
Several enlarged regional lymph nodes.
Multiple hypodense, faintly enhancing masses in the liver measuring less than 38 mm in diameter, inferring metastases. Intrahepatic bile ducts are dilated in the left lobe.
Several bilateral subcentimeter simple renal cortical cysts. A 3 mm calculus is noted in the left kidney's middle calyx.
The prostate gland is enlarged.
Small amount of free pelvic fluid.
Degenerative changes, such as osteophytosis, in the lumbar spine.
Bilateral spondylolysis of L4, with grade I spondylolisthesis of L4 on L5.
Case Discussion
Pathology proved pancreatic ductal adenocarcinoma with local invasion, vascular encasement, regional enlarged lymph nodes, and hepatic metastases.