Case 4

This is an CT study of the abdomen and pelvis which includes post contrast series, showing a large, well defined mass extending from the left upper quadrant to the mid-abdomen. This appears to originate from the pancreatic tail and body as it is inseparable from pancreatic parenchyma. It exerts mass effect on the splenic vein, causing compression with resultant splenic varices extending anterior to the mass. There is also mass effect on other abdominal structures, most prominently on the liver and pancreas which are displaced medially and the kidney which is displaced posteriorly. The mass is made up of locules separated by septations, with the individual locules containing fluid material of varying density. There are a few soft tissue components at the walls peripherally. The septae and soft tissue components within the mass show enhancement on the post-contrast images.

I note that there are no calcifications in the mass, and there are no local enlarged lymph nodes. 

Incidentally, there are two sub-centimetric, hypodense, non-enhancing lesions in the liver, representing simple cysts.

The pancreatic lesion represents a neoplastic, multi-locular mass of mixed fluid and solid components arising from the pancreas, with features most characteristic of a macrocystic mucinous cystadenocarcinoma of the pancreas.

The differential diagnosis includes pancreatic neuro-endocrine tumour; mucinous cystadenocarcinoma that hasn’t undergone malignant transformation is possible, or a serous cystadenoma- however the solid components make these unlikely.

I would raise this case for discussion at hepato-biliary MDT; it will likely be managed by resection.