Case of the Month 2016-07, Page 3

Answer: C) Pancreatic ductal adenocarcinoma

Only 5% of pancreatic adenocarcinomas are found solely in the tail of the pancreas. These masses are typically ill-defined and hypovascular with poor enhancement. They are seen on contrast-enhanced CT as hypoattenuating to isoattenuating to the surrounding pancreatic parenchyma.
The most likely differential consideration for a hypervascular pancreatic tail lesion is an intrapancreatic accessory spleen versus a pancreatic neuroendocrine neoplasm. An alternative though uncommon consideration would be a hypervascular metastasis such as from a renal cell carcinoma.

Which nuclear medicine studies would be most helpful in further evaluation of this lesion?

  • Octreoscan
  • Technetium-99m sulfur colloid scintigraphy
  • Technetium-99m heat-damaged red blood cell (HDRBC) scintigraphy
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