Presentation
Abdominal pain and recent weight loss. Elevated CA19-9 in lab data.
Patient Data
A 68 mm low-enhancing mass is seen in the pancreatic head and uncinate process, which infiltrates the adjacent duodenal wall and causes dilatation of the biliary and pancreatic ducts. There is no vascular encasement or abutment.
An enlarged lymph node with SAD of 10 mm is present in the vicinity of the mass.
In addition, a 15 mm low-enhancing liver mass is evident in segment 7, which becomes isodense with surrounding parenchyma on delayed images and is suspected of metastasis.
A few small, non-enhanced, simple cortical cysts and some peripelvic cysts are seen in both kidneys.
Case Discussion
Pathology-proven case of pancreatic head and uncinate process ductal adenocarcinoma with local invasion to the adjacent duodenal wall, without vascular encasement or abutment, regional lymphadenopathy, and a small liver metastasis.
The main criteria for the unresectability of pancreatic ductal adenocarcinoma are the presence of metastasis and/or vascular invasion, particularly encasement of the celiac trunk and superior mesenteric artery. A structured report should include these two critical findings.
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