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PANCREATIC CANCER WITH SOFT TISSUE METASTATIC DEPOSIT
Authored By: Farrokh Dehdashti and Archana Kantawala.
Patient: 46 year old
History: 46-year-old woman with a diagnosis of pancreatic  adenocarcinoma,status post Whipple's procedure. She now presents for restaging of disease. A recent CT scan demonstrated metastatic involvement of liver.
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Multimedia: 300996_1_submitted.pptx
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Findings: There is a focus of moderately increased FDG uptake within a soft tissue density in the right lower anterior abdominal wall.The 6 mm hypoattenuating lesion within segment 2 of the liver is not appreciated on today's nondiagnostic CT study. However there are
no focal areas of abnormally increased FDG uptake within the liver.
DDx: In the setting on known cancer with positive margins at resection and lymph node involvement, metastatic disease is the most likely differential diagnosis. AN inflammatory or infectious process may demonstrate increased metabolic activity. However the CT charecteristics favor a malignant process. Additionally, there was no recent history of infection or trauma to the region.
Diagnosis: Pancreatic cancer with abdominal wall metastasis
General Discussion:

The pancreas is the tenth most common site of new cancers, but pancreatic cancer is the fourth leading cause of cancer deaths among both men and women, comprising 6% of all cancer-related deaths.

At the time of diagnosis, 52% of all patients have distant disease and 26% have regional spread. The relative 1-year survival rate for pancreatic cancer is only 24% and overall 5-year survival is 5%

Typically, pancreatic cancer first metastasizes to regional lymph nodes, then to the liver and, less commonly, to the lungs. It can also directly invade surrounding visceral organs such as the duodenum, stomach, and colon or metastasize to any surface in the abdominal cavity via peritoneal spread. Occasionaly pancreatic cancer metastasises to unusual sites such as muscle, skin, heart, pleura, stomach, umbilicus, kidney, appendix, spermatic cord, and prostate.

PET scanning appears to be especially useful in detecting occult metastatic disease. Its role in pancreatic cancer evaluation management is still under investigation. False-positive PET scans have been reported in pancreatitis.

By itself, PET does not seem to offer additional benefits to high-quality CT scan. However, recent studies of PET scanning combined with simultaneous CT (PET-CT) suggest that PET-CT is more sensitive than conventional imaging for detection of pancreatic cancer, and that PET-CT findings sometimes change clinical management

Specific Discussion:

The hepatic lesions identified on a contrast enhanced CT were too small to be appreciated on a noncontrast nondiagnostic CT.

 

 

References:

1.Kauhanen SP, Komar G, Seppänen MP, Dean KI, Minn HR, Kajander SA, et al. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. Dec 2009;250(6):957-63. [Medline].

2.Farma JM, Santillan AA, Melis M, Walters J, Belinc D, Chen DT, et al. PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms. Ann Surg Oncol. Sep 2008;15(9):2465-71

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Additional Details:

Case Number: 300996Owner(s): Farrokh Dehdashti and Archana KantawalaLast Updated: 12-07-2011
Anatomy: Gastrointestinal (GI)   Pathology: Neoplasm
Modality: CT, PETAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: ptnm

Case has been viewed 11 times.
Certified by Farrokh Dehdashti on 11-09-2011

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