Pancreatic adenocarcinoma - body/tail with vascular involvement
Presentation
Abdominal pain
Patient Data
Ill-defined, slightly hypoenhancing mass in the pancreas body/tail resulting in a small segment of upstream ductal dilation (not involved by tumor). Occlusion of the splenic vein with short gastric varices, regional adenopathy, and extensive vascular encasement and narrowing including the celiac axis, splenic and common hepatic arteries. Encasement of the SMA without narrowing. Indeterminate left adrenal lesion.
Case Discussion
Advanced presentation of pancreas body/tail adenocarcinoma which has extensive vascular involvement. Tumors in the pancreas neck, body, and tail frequently present later with more advanced disease due to not obstructing the common bile duct and "sounding the alarm" with jaundice.
While the primary tumor is relatively subtle, the appearance of the primary tumor with splenic vein occlusion and soft tissue encasement/narrowing of the arteries are highly specific features and allow you to confidently diagnose pancreas adenocarcinoma.