FINAL DIAGNOSIS:
Liver, mass, CT-guided needle core biopsy - Adenocarcinoma, consistent with pancreatic primary.

A later presentation of pancreatic adenocarcinoma given the location of the tumor within the pancreatic tail. When the primary is in the pancreatic head, the patient may present early with jaundice or pancreatitis. However, in this case, the patient presents with colonic obstruction. There is also obstruction of the splenic vein with short gastric varices, obstruction of the left renal vein and upper pole calyx with delayed left nephrogram, and extensive metastases within the left hepatic lobe.