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Pancreatic Carcinoma

Sutcliffe JBS - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Brooke Army Medical Center

ABSTRACT

Diagnosis: Pancreatic Carcinoma

History: Painless jaundice.

Findings: The images through the level of the liver and porta hepatis demonstrate extrahepatic and intrahepatic biliary ductal dilatation. Images through the level of the pancreas demonstrate a 3cm mass in the head of the pancreas. Pelvic images demonstrate thrombi within the right common iliac and left common femoral vein.

Ddx: Pancreatic carcinoma Mass due to chronic pancreatitis Cholangiocarcinoma Duodenal/ampullary carcinoma

Dxhow: CT imaging characteristics, elevated CA 19-9, and clinical history highly suggests the diagnosis of pancreatic CA and make other etiologies far less likely. The finding of multiple DVTs also helps confirm the diagnosis (Trousseau's sign - strongly associated with pancreatic carcinoma). Patient underwent a Whipple's procedure. Definitive diagnosis was made by post-operative tissue path examination: FINAL DIAGNOSIS: (A) PERITONEAL NODULE, BIOPSY: <li> LYMPH NODE IDENTIFIED (SEE COMMENT). <li> BENIGN FIBROADIPOSE TISSUE WITH FAT NECROSIS. (B) DISTAL STOMACH/DUODENUM/HEAD OF PANCREAS/COMMON BILE DUCT, WHIPPLE PROCEDURE: - MODERATELY TO POORLY DIFFERENTIATED PANCREATIC DUCTAL ADENOCARCINOMA. - TUMOR IS LOCATED WITHIN THE HEAD OF THE PANCREAS. - TUMOR IS 4 CM IN GREATEST DIMENSION. + - IN SITU CARCINOMA IS ALSO PRESENT. TUMOR INVADES PERIPANCREATIC ADIPOSE TISSUE, COMMON BILE DUCT WALL,AND DUODENUM WALL AND MUCOSA. - METASTATIC CARCINOMA IS PRESENT IN FIFTEEN OUT OF TWENTY-TWO REGIONAL LYMPH NODES EXAMINED (15/22). - DEEP PANCREATIC MARGINS (ANTERIOR AND POSTERIOR RETROPERITONEAL MARGINS) ARE INVOLVED BY INVASIVE CARCINOMA. - DISTAL PANCREATIC, PANCREATIC DUCT, COMMON BILE DUCT, GASTRIC AND DUODENAL MARGINS ARE NOT INVOLVED BY INVASIVE CARCINOMA. - LYMPHOVASCULAR INVASION IS PRESENT. - PERINEURAL INVASION IS PRESENT.

Exam: Elavated CA 19-9 = 185 (37 upper limits normal)

No MeSH data available.


Axial CT with oral contrast only at the level of the porta hepatis. Can you detect the abnormality?
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MPX1371_synpic20119: Axial CT with oral contrast only at the level of the porta hepatis. Can you detect the abnormality?


Pancreatic Carcinoma

Sutcliffe JBS - MedPix

Axial CT with oral contrast only at the level of the porta hepatis. Can you detect the abnormality?
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1371&req=5

MPX1371_synpic20119: Axial CT with oral contrast only at the level of the porta hepatis. Can you detect the abnormality?

View Article: MedPix Image - MedPix Case

Affiliation: Brooke Army Medical Center

ABSTRACT

Diagnosis: Pancreatic Carcinoma

History: Painless jaundice.

Findings: The images through the level of the liver and porta hepatis demonstrate extrahepatic and intrahepatic biliary ductal dilatation. Images through the level of the pancreas demonstrate a 3cm mass in the head of the pancreas. Pelvic images demonstrate thrombi within the right common iliac and left common femoral vein.

Ddx: Pancreatic carcinoma Mass due to chronic pancreatitis Cholangiocarcinoma Duodenal/ampullary carcinoma

Dxhow: CT imaging characteristics, elevated CA 19-9, and clinical history highly suggests the diagnosis of pancreatic CA and make other etiologies far less likely. The finding of multiple DVTs also helps confirm the diagnosis (Trousseau's sign - strongly associated with pancreatic carcinoma). Patient underwent a Whipple's procedure. Definitive diagnosis was made by post-operative tissue path examination: FINAL DIAGNOSIS: (A) PERITONEAL NODULE, BIOPSY: <li> LYMPH NODE IDENTIFIED (SEE COMMENT). <li> BENIGN FIBROADIPOSE TISSUE WITH FAT NECROSIS. (B) DISTAL STOMACH/DUODENUM/HEAD OF PANCREAS/COMMON BILE DUCT, WHIPPLE PROCEDURE: - MODERATELY TO POORLY DIFFERENTIATED PANCREATIC DUCTAL ADENOCARCINOMA. - TUMOR IS LOCATED WITHIN THE HEAD OF THE PANCREAS. - TUMOR IS 4 CM IN GREATEST DIMENSION. + - IN SITU CARCINOMA IS ALSO PRESENT. TUMOR INVADES PERIPANCREATIC ADIPOSE TISSUE, COMMON BILE DUCT WALL,AND DUODENUM WALL AND MUCOSA. - METASTATIC CARCINOMA IS PRESENT IN FIFTEEN OUT OF TWENTY-TWO REGIONAL LYMPH NODES EXAMINED (15/22). - DEEP PANCREATIC MARGINS (ANTERIOR AND POSTERIOR RETROPERITONEAL MARGINS) ARE INVOLVED BY INVASIVE CARCINOMA. - DISTAL PANCREATIC, PANCREATIC DUCT, COMMON BILE DUCT, GASTRIC AND DUODENAL MARGINS ARE NOT INVOLVED BY INVASIVE CARCINOMA. - LYMPHOVASCULAR INVASION IS PRESENT. - PERINEURAL INVASION IS PRESENT.

Exam: Elavated CA 19-9 = 185 (37 upper limits normal)

No MeSH data available.