*55-year-old male patient with epigastric pain.
What is the most likely diagnosis?
Answer
Case Discussion:
US and Doppler US images revealed hypoechoic mass in pancreatic head with dilated main pancreatic duct. CT demonstrated poorly defined mass in pancreatic head with pancreatic atrophy and PET-CT showed a mass on pancreatic head with high FDG uptake.
Answer: Pancreatic ductal carcinoma
Pancreatic cancer accounts for about 5% of all cancer deaths, about 22% of all deaths because of gastrointestinal malignancy. Pancreatic ductal carcinoma is the most common malignancy of all pancreatic neoplasms.
Ultrasound findings:
• generally hypoechoic mass
• a double duct sign can be seen
CT findings:
• poorly defined masses
• a double duct sign can be seen
MRI findings:
• T1: hypointense c.f. normal pancreas
• T1 FS: hypointense c.f. normal pancreas
• T1 + C: slower enhancement than normal pancreas, so dynamic injection with arterial phase imaging with fat saturation is best
• T2: variable
• MRCP: double duct sign can be seen
References:
1. Evans DB, Pisters PW, Abbruzzese JL. Pancreatic cancer. Springer Verlag. (2002) ISBN:0387951857.
2. Lu DS, Reber HA, Krasny RM et-al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol. 1997;168 (6): 1439-43.
3. Mergo PJ, Helmberger TK, Buetow PC et-al. Pancreatic neoplasms: MR imaging and pathologic correlation. Radiographics. 17 (2): 281-301.