A Rare Pancreatic Tumor in a 52-Year-Old Chinese Woman

Abstract

Question: A 52-yearold Chinese woman without any significant past medical history presented with 1 month of postmenopausal bleeding without abdominal pain, fever, jaundice, weight loss, or other symptoms. General physical examination did not reveal any abnormality. Abdominal examination showed a large (10 cm), firm, fixed mass with well-defined borders in the suprapubic area. Routine laboratory tests and tumor markers including CA 19-9 and CA-125 were within normal range. Computed tomography (CT) showed an approximately 10 10-cm hysteromyoma arising from the anterior wall of uterus and the other mass of 4 cm in diameter within the endometrial cavity (Figure A). The latter one was proved to be grade I endometrial carcinoma by endometrial biopsy. Simultaneously, a 2.9 3.4-cm heterogeneous enhanced mass in the pancreatic head was accidentally discovered in the preoperative CT examination (Figure B). Exploratory laparotomy was performed. Intraoperatively, the tumor in the pancreatic head was found to directly invade the superior mesenteric vein and could not be resected. Hysterectomy and bilateral adnexectomy were performed after pancreatic tumor biopsy with prostatic trocar. What is the most likely diagnosis of the pancreatic mass? Is it a primary or a secondary tumor? Look on page 659 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.