Presentation
Obstructive jaundice ?gallstones.
Patient Data
Low echogenicity mass within the distal common bile duct. Common bile and pancreatic ducts are dilated (double duct sign). Distended gallbladder with internal echogenicity.
Hypodense pancreatic head / uncinate process mass. Dilatation of the main pancreatic duct with associated atrophy of the pancreatic neck and proximal body. Dilatation of the intra and extrahepatic ducts with the common bile duct measuring up to 1.2 cm. Gallbladder is markedly distended.
This hypodense mass does not abut the superior mesenteric artery or vein. No enlarged lymph nodes using short axis criteria. No focal liver lesion. Small volume of pelvic free fluid.
Endoscopic ultrasound (EUS) demonstrates a pancreatic mass with dilated common bile and pancreatic ducts. FNA was performed.
Histology
MICROSCOPIC DESCRIPTION: The smears and cell block section contain sheets and groups of malignant epithelial cells. The tumor cells demonstrate high N:C, irregular nuclear membranes, coarsely granular chromatin, prominent nucleoli and foamy cytoplasm. The background contains few sheets of benign duodenal epithelium and blood.
DIAGNOSIS: FNA Pancreatic head mass: Adenocarcinoma.
Case Discussion
Pancreatic adenocarcinoma often presents at an advanced stage due to its non-specific and occult symptoms. Involvement of the superior mesenteric vessels is important to assess with >180 degree encasement usually a contraindication to resection.
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