Mobile Abdominal Mass Likely of Pancreatic Origin

Abstract

Mobile abdominal masses are rare. Of these mobile masses, mesenteric masses are the most common. This is a case report, however, of mobile abdominal mass that behaved like a mesenteric mass, but was highly suggestive of pancreatic pathology. An 85 year old male with medical history of bladder cancer s/p failed TURBT and BCG therapy, CKD stage V, and coronary artery disease s/p PTCA was referred by his PCP for a two month history of abdominal pain, nausea, vomiting and abdominal mass found on CT Abdomen & Pelvis on outpatient work-up. Patient reported nonradiating epigastric pain, occurring roughly 3 hours after eating, and waxing and waning in intensity. He had associated 10 pound weight loss, increased fatigue, loss of appetite, and early satiety. He denied any pruritus, jaundice, or changes in stool caliber/color. As mentioned before, PCP had a CT Abdomen & Pelvis w/o contrast done 1 week prior to admission which showed a ˜3.6 x 4.5 cm mass in the uncinate process of the pancreas, with mass effect on the 2nd portion of the duodenum and stomach distention (Image 1). On physical examination, there was a minimally palpable mass in the epigastric region. Liver function tests were within normal limits, however tumor markers were abnormal; CA 19-9 393; and CEA 3.1. CA 125 was normal at 24.9. While inpatient, further imaging was done for staging purposes. CT Thorax w/o contrast showed multiple bilateral pulmonary nodules and new bilateral pleural effusions. Interestingly, a repeat CT Abdomen & Pelvis now showed that the mass had migrated to the left of the epigastrium (Image 2). Gastroenterology service planned to do an EUS/FNA biopsy of mass to assess for pancreatic neoplasm and evaluation for duodenal/biliary stent placement. However, the day before the procedure, patient had an NSTEMI. Patient and his family subsequently decided not to pursue any further investigations for the mass out of fear of further worsening health. Since the mass moved, patient expressed resolution of his nausea, vomiting and abdominal discomfort and wanted to go home. Although a biopsy would have been the definitive answer to confirm the etiology of the mass, given the symptom presentation, history of cancer, elevated lab values of CA 19-9 and CEA along with CT findings, it is likely that the abdominal mass was pancreatic in origin. This is a unique case as it demonstrates that not all mobile masses in the abdomen will be of mesenteric type.Figure 1Figure 1