MODERATELY DIFFERENTIATED DUCTAL CARCINOMA PANCREAS INVOLVING PERIAMPULLARY REGION

  • Shumaila Seemi Malik
  • Safdar Ali Malik
  • Muhammad Bin Zulfiqar
  • Adila Iqbal

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 6th 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).
Section
Surgery & Allied