Presentation
Abdominal discomfort.
Patient Data
Very large pancreas head mass with broad contact of the first proximal second portion of the duodenum, potential invasion. Dilation of the main pancreas duct with small cyst in the splenic hilum, presumably the sequelae of prior pancreatitis. No biliary obstruction. Borderline peripancreatic lymph nodes. No definite arterial involvement. Abutment of the proximal superior mesenteric vein. Numerous relatively small liver lesions with an appearance typical for metastases, particularly the larger lesion in hepatic segment 7 near the dome and along the periphery of hepatic segment 3. The splenic vein is occluded, presumably chronically related to prior pancreatitis, with short gastric collaterals.
Case Discussion
Teaching case illustrating advanced presentation of a larger pancreas head adenocarcinoma which has only resulted in dilation of the main pancreas duct and has not resulted in biliary obstruction, thus accounting for later presentation. This patient unfortunately has presented with liver metastases and would not be resectable.
This patient also likely had a prior episode of pancreatitis accounting for small amount of fluid/collection in the splenic hilum and occlusion of the splenic vein with characteristic short gastric collaterals.