Pancreatic cancer

An ill-defined, lobulated mass was seen at the uncinate process measuring (39.5 x 43 x 42) mm, with no distal pancreatic atrophy or calcification. The mass was non-calcified, exhibits a central hypodense/necrotic area with predominant irregular peripheral enhancement, no pancreatic duct/CBD narrowing/abrupt cut-off or upstream dilatation.

There is a lost fat plane between the mass and distal second and third duodenal segments with duodenal wall thickening and luminal deformation without complete obstruction; duodenal invasion is likely. Limited extension into jejunal mesentery, no transverse mesocolon involvement.

The mass makes <180° solid soft tissue contact with the SMV circumference, the contact length of 30mm with focal vessel contour irregularity and intra luminal non-occlusive floating thrombus suggesting vessel invasion (no enhancement noted within likely represents bland thrombus), no collaterals. The celiac axis, hepatic artery, SMA, and portal vein show no solid soft-tissue contacts, and no thrombosis, however encasement of the SMA first branch was seen.

Hazy attenuation/stranding is seen heading superiorly from the mass along the lateral aspect of the SMA (without abutting the vessel wall) and anterior to the right diaphragmatic crura, suggesting perineural spread.

Several locoregional and extra regional lymph nodes were seen at the peripancreatic, periportal, preaortic, and portocaval space. No ascites or omental nodules.

Liver: at least three suspicious hypoattenuating/hypo enhancing, ill-defined masses were seen at segment 7, the other two less readily identifiable are seen at the subcapsular aspect of segment 4a.