Presentation
Epigastric pain and significant recent weight loss.
Patient Data
A 48 mm low-enhancing mass is noted in the pancreatic body, accompanied by distal duct dilatation and parenchymal atrophy. The mass encases the celiac trunk, proximal of common hepatic artery and splenic artery, and abuts the superior mesenteric artery. Additionally, the portal confluence and splenic vein are encased and narrowed by the mass. The fat planes between the mass and gastric lesser curvature are obliterated.
A few enlarged lymph nodes are seen in the peripancreatic regions.
A small volume of free fluid is present in abdominopelvic spaces.
Several hepatic low-enhancing masses are seen less than 18 mm, inferring metastases.
The gallbladder is not seen at the anatomical location due to prior resection.
Case Discussion
This case demonstrates a pathology-proven pancreatic ductal adenocarcinoma with vascular encasement and abutment, small regional lymphadenopathy, and hepatic metastasis.
The primary factors indicating that pancreatic ductal adenocarcinoma is unresectable are the existence of metastasis and/or invasion of blood vessels, specifically encasement of the celiac trunk and superior mesenteric artery. A comprehensive report ought to incorporate these essential discoveries.
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