Presentation
Further work-up pancreatic lesions.
Patient Data
There is an ill-defined hypovascular lesion at the pancreatic head measuring approximately 1.5 cm, just adjacent/posterior to the CBD. This appears to have some restricted diffusion.
The larger tail of the pancreas cystic lesion has increased, measuring now approximately 6.0 x 5.5 x 6.2 cm (opposed to 4.5 x 4.0 x 5.2). Also, there is a marginal increase in the uncinate process cyst, measuring 3.0 x 2.6 x 2.4 cm (opposed to 2.5 x 2.5 x 2.2 cm). Other small pancreatic cysts measure less than 1.0 cm and are unchanged. All the cysts have thin walls and do not show solid enhancing components. The main pancreatic duct is not dilated. The pancreatic parenchyma has otherwise normal signal intensity.
There is no biliary tree dilatation. The liver, spleen, and adrenal glands have normal appearances. Both kidneys have multiple simple cortical cysts. There is no lymphadenopathy or free fluid within the superior abdomen.
Small hypovascular area at the pancreatic head.
Unfortunately, this patient passed away a few months after this scan. Post mortem study has revealed, among others:
Pancreas: Sections through the pancreatic head lesion show a moderately differentiated adenocarcinoma, with invasive angulated glands lined by pleomorphic epithelial cells. The macroscopically described pancreatic cysts at the uncinate process and tail are focally lined by flat mucinous epithelium. The remainder of the pancreas is largely autolysed, however, has retained lobular architecture. Towards the tail of the pancreas, there is extensive fat necrosis.
Conclusion: [...] 18 mm moderately differentiated adenocarcinoma within the pancreatic head, resulting in extrinsic compression of the distal common bile duct, with secondary dilation of intrahepatic bile ducts.
30 mm intraductal papillary mucinous neoplasm at the uncinate process, with a second separate 60 mm intraductal papillary mucinous neoplasm towards the tail. [...]
Case Discussion
This case illustrates two types of pancreatic lesions: