Presentation
Severe abdominal pain
Patient Data
A hypoechoic lesion with irregular borders measuring 75 x 49 mm in the body of the pancreas.
Abdominal CT scan with IV and oral contrast demonstrates a 77 x 48 mm low-enhancing mixed cystic and solid mass with infiltrative components in the body of the pancreas that extends to the lesser sac and is accompanied by distal parenchymal atrophic changes and main pancreatic duct dilation.
Effacement of the fat plane between the pancreatic mass and the left liver lobe, accompanied by a 24 x 22 mm hypodense mass in the left liver lobe, is seen in continuity with the pancreatic mass, which is mostly suggestive of direct invasion.
Encasement associated with the narrowing of adjacent arteries (segment of the celiac artery just before its branching point, proximal part of the splenic artery, left gastric artery, common hepatic artery, and its branches) is seen.
Narrowing of the superior mesenteric vein adjacent to the portal confluence is seen.
The effacement of the fat plane between the pancreatic mass and the inferior part of the gastric lesser curvature is noticeable.
Several enlarged lymph nodes are seen in the peripancreatic regions.
The coronary reformatted image better defines the craniocaudal extent of the tumor and its relationship to the adjacent vasculature.
Case Discussion
An ultrasound-guided biopsy was done.
Macroscopic examination:
The specimen received in formalin is composed of three pieces of creamy tan needle-like soft tissue measuring 0.3 x 0.1 cm submitted in one block.
Microscopic examination:
Sections reveal malignant lesions composed of irregular glands lined by atypical columnar and cuboidal cells invading the desmoplastic stroma.
The malignant cells are positive for CK7, CD19, and CEA and negative for CK20 and CDX2.
Diagnosis: adenocarcinoma
Unable to process the form. Check for errors and try again.