Pancreatic adenocarcinoma (ultrasound)

Case contributed by Yaïr Glick
Diagnosis certain


Epigastric pain, nausea, and constipation for past few days.

Patient Data

Age: 70 years
Gender: Male

Hypoechoic lesion with irregular borders measuring 2.7 x 1.3 cm (LL x AP) in the body of the pancreas. The main pancreatic duct is not dilated.

Several hyperechoic lesions up to 2 cm in length in the right hepatic lobe - known hemangiomas. The CBD is 7 mm in diameter - borderline.

8-mm long milk of calcium cyst in right kidney.

Prostate volume is 35 cm3 - normal.

CT stone protocol 11 yr later


No urinary stone or hydronephrosis was identified.

Cylindrical bronchiectasis, several bronchi are obstructed, and tree-in-bud infiltrates in the lung bases.

The pancreas was resected almost completely (only a small part of the head of the pancreas has been left in situ, as per the surgical report), as well as the left adrenal gland and the spleen.

Case Discussion

Pancreatic ductal adenocarcinoma appears hypoechoic on ultrasonography but this is a non-specific sign.

The patient had a CT for tumor staging done at another institution.
Radical partial pancreatectomy was performed.

Distal pancreatectomy, splenectomy and adrenalectomy:
Moderately differentiated ductal adenocarcinoma 2.5 cm in maximal diameter. Perineural and perivascular invasion.
2 out of 5 peripancreatic lymph nodes are involved by adenocarcinoma. No extracapsular extension.
1 out of 6 splenic hilar lymph nodes involved by adenocarcinoma. No extracapsular extension.
Areas of chronic inflammation and fibrosis.
Pancreatic proximal and distal surgical margins, spleen and adrenal negative for malignancy.

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