Presentation
Abdominal discomfort.
Patient Data
Rounded, hazy, low-attenuation mass in the pancreas head and uncinate process. Abutment of the SMA and probably minimal contact of the SMV. Mild ductal dilation and atrophy of the remainder of the pancreas. Midly dilated common and central bile ducts, and moderately dilated gallbladder. Small lesions in hepatic segment 7 and 4.
Case Discussion
Large mass of the pancreas head/uncinate process with typical appearance of pancreas adenocarcinoma. When staging these tumors, be sure to evaluate vascular contact, which is described as abutment (<180 degrees) or encasement (>180 degrees). In this case, hazy tumor abuts the SMA and may barely contact the SMV. There is a small mass in hepatic segment 7 concerning for a metastases, and that warrants evaluation with either US-guided biopsy or MRI to properly stage this tumor. MRI is not necessary in this case as the mass is quite suspicious for metastases and will simply delay a biopsy. The diagnosis of adenocarcinoma was confirmed with endoscopic biopsy.
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