The patient had undergone a CT spine (not shown; cannot be accessed) for long-standing back pain, where a pancreatic mass was incidentally discovered. CT pancreas clearly showed the mass to occlude the portal confluence and envelop the CHA, rendering it inoperable. A biopsy from the mass was obtained by endoscopic ultrasound (EUS).

Histopathology report:
Pancreatic undifferentiated carcinoma (see comment).
Comment: Cellular neoplasm with highly atypical cells, consistent with
undifferentiated carcinoma of the pancreas. There are cells resembling
osteoclast-like giant cells making undifferentiated carcinoma with
osteoclast-like giant cells in the differential.

A follow-up CT several months later showed hepatic and retroperitoneal metastases, as well as ascites. An internal biliary stent had been inserted after the CBD had been occluded due to compression by the mass.