2017-04-19 20:33:44 UTC

A Pancreatic Mass Lesion

April 19, 2017

Gastroenterology image challenge highlights the case of a 61-year-old woman with a 3-month history of general fatigue, referred to the hospital for detailed assessment of jaundice.

Gastroenterology Clinical Image Challenge:  A 61-year-old woman with a three-month history of general fatigue was referred to the hospital for detailed assessment of jaundice. Blood findings were as follows: total bilirubin, 7.47 mg/dL; aspartate aminotransferase, 164 U/L; alanine aminotransferase, 275 U/L; lactate dehydrogenase, 270 U/L; and alkaline phosphatase, 2302 U/L without elevated tumor markers. Dynamic CT revealed a heterogeneous enhanced mass in the pancreatic head with a diameter of 40 mm and a smooth margin (Figure A). Distant metastasis and lymph node swelling were undetectable. T1- and T2-weighted MRI revealed a tumor with hypointense and hyperintense areas, respectively (Figures B, C). MRCP showed tumor compression of the common bile duct, an obviously dilated biliary tract, and that the pancreatic duct was not dilated and did not communicate with the tumor (Figure D). Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) revealed FDG accumulation in the tumor with a max standardized uptake volume of 5.87 (Figure E). Drainage using a biliary stent was followed by surgical resection. The tumor was surrounded by a fibrous capsule and included a cystic, hemorrhagic area (Figure F).

What is the diagnosis?

To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play

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