MODERATELY DIFFERENTIATED DUCTAL CARCINOMA PANCREAS INVOLVING PERIAMPULLARY REGION

Abstract

Abstract

Background:  Pancreatic carcinoma has very poor prognosis. Curative management is only surgery. It is documented in literature studies that only 10 - 15% of patients suffering from adenocarcinoma go for surgical resection and surgery is radical in about half of these cases.¹ In this case we will discuss that how imaging, ultrasonography in usual and CT in particular are used to identify patients with probable resectable tumors.

Methods:  We report a case of 65 years old man who referred to us for imaging from surgical emergency department with complains of obstructive jaundice. Ultrasonography revealed a hypo echoic mass in peri-ampullary region with dilatation of common bile duct, Intra hepatic biliary channels, pancreatic duct and distension of Gall Bladder. CT scan showed a hetero-geneously enhancing mass in periampullary region in relation to head of pancreas. There was no evidence of

Malik S.S.¹

Associate Professor

Department of Radiology, AIMC / Jinnah Hospital, Lahore

Malik S.A.²

Professor of Radiology, SIMS / Services Hospital, Lahore

Zulfiqar M.B.³

Dept of Radiology, Services Hospital, Lahore

Iqbal A.⁴

Department of Radiology, Services Hospital, Lahore

any vascular invasion.

Results:  The patient underwent pancreaticoduodenec-tomy according to Whipple's procedure. Histological examination of the specimen proved a moderately dif-ferentiated ductal adenocarcinoma of the pancreas.

Conclusion:  With the help of imaging USG in usual and CEMDCT in particular, a radiologist can play major role to guide surgeon about resectability of tumor, while describing the involvement of surround-ing structure and size of tumor.

Introduction:  Incidence of Pancreatic carcinoma is 6-7 per 100,000 per year in Western Europe. Among these most common (85%) are ductal adenocarcinoma, have male predominance (male: female 1.5:1) and usually occur above 6^th decade of life.² Whether tum-ors are small or large, majority (above 80%) are un-resectable at time of diagnosis due to advance local extension (40%) and distant metastasis in Liver and Lymph nodes.³ Computed tomography (CT) is the imaging investigation of choice as it is easily available and highly sensitive and specific to diagnose and stage pancreatic adenocarcinoma.

Key Words:  Periampullary, Tumor resectability, pan-creatic mass.

Abbreviations:  CEMDCT (Contrast Enhanced Multi Detector Computed Tomography), CBD (Common Bile Duct), IHBC (Intra Hepatic Biliary Channels), MPR (Multi Planar Reconstructions), MIP (Maximum Intensity Projection).