Pancreatic adenocarcinoma (unresectable)

Case contributed by Dr Yair Glick

Presentation

Right flank pain.

Patient Data

Age: 75 years
Gender: Female

Underwent CT stone protocol which ruled out urinary lithiasis.
There was, however, "fat stranding and fullness around the coeliac trunk and SMA."

Contrast-enhanced CT was performed. Of note, the patient was given positive contrast per os, despite the radiologist's explicit instruction that water alone be given per os at the CT unit.

Pancreatic neck soft tissue mass slightly hypodense to the pancreas, completely encasing the coeliac trunk and SMA as well as surrounding and narrowing the splenic vein and SMV near the portal confluence. The common bile duct and main pancreatic duct are not dilated.
Several small cystic dilatations along the main pancreatic duct, possibly IPMN. The pancreatic body and tail are atrophied.
Hepatic hilar lymphadenopathy measuring up to 22 mm (short axis) and hepatogastric ligament lymphadenopathy. No evidence of hepatic spread.
Findings are consistent with unresectable pancreatic adenocarcinoma.The coeliac trunk is narrow (stenotic?) at its origin.

Bilateral elastofibroma dorsi.
Small cyst in each kidney.
The abdominal aorta shows soft and calcified plaque.

Case Discussion

The JACC TNM stage for this tumour is T4N1M0, which corresponds to stage III.

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Case information

rID: 56211
Case created: 18th Oct 2017
Last edited: 24th Oct 2017
Inclusion in quiz mode: Included
Institution: Hillel Yaffe Medical Center

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