Pancreatic carcinoma

Case contributed by Dr J. Ray Ballinger

Presentation

Epigastric discomfort, anorexia and 20-pound weight loss over the preceding 2 months.

Patient Data

Age: 70 years
Gender: Male
Modality: Barium

The first image is a prone view from UGI series showing mass effect on 2nd and 3rd portions of the duodenal sweep.

The second image is an RAO view from UGI series showing mass effect on 3rd portions of the duodenal sweep with mild dilatation of proximal duodenum.

Modality: CT
A subtle mass effect is seen on the 2nd and 3rd portions of the duodenum on the upper GI series. On CT, a 6 cm mass is seen arising from the uncinate process of the pancreas. Because of it's position below the common bile duct, it was not obstructing the duct (documented on ultrasound) so there was no jaundice and minimal changes in liver enzymes. The pancreas and therefore this mass were obscured on ultrasound because of overlying bowel gas.

Case Discussion

Pancreatic cancer is the 4th leading cause of death in the United States increasing with age over 40. About 1/3 of cases are related to smoking. Most are of unknown cause though a very small number have a hereditary basis.

At the time of diagnosis, only about 20% of pancreatic carcinomas can be removed by surgery and in these cases cure rates are under 50%. In nonresectable cases, median survival is less than one year.

Differential diagnosis

  • Lymphoma
  • Focal pancreatitis
  • Metastasis
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Case Information

rID: 23672
Case created: 2nd Jul 2013
Last edited: 18th Sep 2015
Inclusion in quiz mode: Included

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