Pancreatic tail cancer in the setting of pancreatitis with a review of the literature: A case report

Abstract

Environmental risk factors for pancreatic cancer include acute and chronic pancreatitis, obesity, and tobacco use. Differentiating a pancreatic neoplasm in a patient with pancreatitis can be challenging due to their similar presentations. A 57-year-old African American man with a history of congestive heart failure, pancreatitis, and incomplete pancreas divisum presented with an epigastric abdominal pain that radiated to his back. Imaging showed necrotizing pancreatitis, a developing splenic infarct, and a mass at the pancreas tail. The patient was discharged with pain medications and was recommended follow-up imaging after resolution of his pancreatitis. He was readmitted to the emergency department 2 weeks later with recurrent acute abdominal pain. Computed tomography scan of abdomen and pelvis followed by magnetic resonance imaging and endoscopic ultrasound revealed an infiltrative pancreatic tail mass. Biopsy of the mass confirmed a locally advanced pancreatic tail adenocarcinoma. Chronic pancreatitis is associated with pancreatic cancer. Practitioners should be aware of the co-existence of chronic pancreatitis and pancreatic cancer, and the initial steps to evaluate a malignancy in chronic pancreatitis.

Keywords: chronic pancreatitis; imaging; pancreatic ductal adenocarcinoma; pancreatic neoplasm.

FIGURE 1

CT with IV contrast demonstrates diffusively infiltrative lesion within pancreatic tail with medial spleen involvement.

FIGURE 2

MRI of abdomen and pelvis demonstrating a predominantly T2 hyperintense fluid collection (top left image, T2 HASTE). Dynamic contrast enhanced images show progressive peripheral enhancement and central nonenhancement (middle images, T1 VIBE precontrast on the left, arterial phase, portal venous phase, and delayed phase images post IV Gadolinium contrast from left to right). There are additional areas of peripheral diffusion restriction (bottom left = ADC map, bottom right = B800 DWI). These findings are consistent with walled off necrosis.

FIGURE 3

EUS of hypoechoic pancreatic tail mass measuring at least 3.5 cm.