Presentation
Abdominal pain.
Patient Data
There is a very large mass involving the pancreas tail which is invading and surrounding several adjacent structures. Most notably for the patient's presentation, it is obstructing and invading into the colon at the splenic flexure, with upstream moderate to severe colonic dilation and some distal small bowel dilation as well. Additionally, it is surrounding the left adrenal gland and extending into the left renal hilum, and obstructing the left renal vein and also encasing and narrowing the left renal artery, resulting in some left renal enlargement and delayed enhancement and also isolated calyceal dilation in the left upper renal pole. There are left periureteric varices and a few smaller retroperitoneal varices likely accounting for collateralized kidney drainage. This mass is also obstructing the splenic vein resulting in upper abdominal/short gastric collaterals. There is a component of soft tissue extending about the mid abdominal aorta as well. Borderline upper abdominal lymph nodes. Extensive and infiltrative metastases involving the liver, most pronounced within the left hepatic lobe.
Case Discussion
Teaching case of advanced pancreatic adenocarcinoma, with a later presentation due to lack of obstruction of the common bile duct, and the patient will not present earlier with jaundice as with a typical pancreas head mass. This tumor has resulted in malignant obstruction of the large bowel and encasement of multiple adjacent structures, including the left renal hilum, resulting in collateralized left renal venous drainage with retroperitoneal and periureteric varices.
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