Presentation
Obstructive jaundice
Patient Data
A small ill-defined hypoenhancing mass lesion is seen in the vicinity of the pancreatic head, causing upstream biliary dilatation in the CBD and pancreatic duct (double duct sign).
Mild fat stranding surrounding the pancreatic head is noted.
The GB is distended, with no peri-cholecystic reaction (Courvoisier's sign).
Few small peri-pancreatic and aortocaval lymph nodes noted.
No perivascular spread.
Note also, small left inguinal hernia admitting only fat.
Case Discussion
Although pancreatic adenocarcinoma is a very serious disease, this patient is lucky as he was presented in this early stage (see: staging of pancreatic adenocarcinoma). Usually, patients with pancreatic cancer involving the pancreatic head present with obstructive jaundice rather than the patients with body/tail carcinoma who are presented by metastatic disease.
Teaching points:
- pancreatic adenocarcinomas are usually hypoenhancing (in contrast to pancreatic neuroendocrine tumors, which are usually hyper-enhancing).
- normally the pancreas enhances mostly in the arterial phase, so adenocarcinomas are best assessed in the arterial phase, where the best contrast between them and the normal pancreatic tissue is noted (normal pancreas hyper-enhancing while the adenocarcinoma is hypoenhancing).
- in the setting of pancreatic adenocarcinoma, any abnormal appearance around the related vessels (starting from peri-vascular haze to peri-vascular soft tissues) should be mentioned in the report as a suspected peri-vascular spread, as this may alter the surgical decision.
- always pay attention to the blood supply of the liver in the cases of pancreatic adenocarcinoma.
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