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Pancreatic adenocarcinoma - body

Case contributed by Michael P Hartung
Diagnosis almost certain

Presentation

Abdominal discomfort.

Patient Data

Age: 55 years
Gender: Male

Ill-defined soft tissue thickening and stranding in the pancreas body, with ductal dilation and atrophy of the tail. Narrowing the splenic vein at the confluence. Abutment of the splenic artery, possibly the superior mesenteric artery, and perhaps encasement of the superior mesenteric vein. Mildly enlarged peripancreatic and porta hepatic lymph nodes. Left adrenal nodule. Borderline retroperitoneal lymph nodes. The rounded left presacral nodule could be a nerve sheath tumor (not worked up further). 

Case Discussion

Pancreas body adenocarcinoma with some overlapping features of acute pancreatitis. It is important to feel comfortable distinguishing these two diagnoses, or at least knowing when to raise the alarm of a potential adenocarcinoma and need for further workup (generally short term follow up with MRCP or endoscopic ultrasound with CA 19-9). 

In this case, the upstream atrophy of the tail with ductal dilation and narrowing of the splenic vein is highly suggestive of adenocarcinoma despite some of the surrounding stranding, and this diagnosis was confirmed with an endoscopic biopsy. 

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