Axial (A, B, C) and coronal (D, E, F) images of a patient presenting with left renal colic. (IMAGE)
Caption
On the unenhanced CT of the abdomen and pelvis (A, D), no kidney or ureteral stones are identified. As an incidental finding, discrete peripancreatic fat stranding is present around the pancreatic head which leads to an effacing of the normal parenchymal contour (short open arrow in (A)). The finding was suspicious of a pancreatic head tumour. The presence of a tumour (long open arrow) is confirmed on diffusion-weighted (DWI) (B) and T2-weighted (C) MR imaging performed a few days later. On maximum intensity projection magnetic resonance cholangiopancreatography (MIP MRCP), there is no dilation of the main pancreatic duct [short arrows in (E) and (F)] or the extrahepatic bile ducts (long arrow in (F)). The tumour (long open arrow in (E)) causes slight dilation of some surrounding side branches (thin lines in (E) and (F)). Amylase and CA 19–9 were normal. After pancreaticoduodenectomy (pT2N0L0V1Pn1R1), the histopathological analysis showed pancreatic ductal adenocarcinoma, positive for MUC1, MUC5A, p53mut and loss of SMAD4.
Credit
By J-Matthias Löhr, Miroslav Vujasinovic, Nikolaos Kartalis, Philipp Osten.
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License
CC BY-NC