What Causes Abdominal Pain When Diagnosed With Cysts In The Pancreas?
PET can diagnose this leasion.
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Can you please mention the exact description of this mass around celiac artery?
Are there any stones in pancreatic ducts? Is the diarrhea a fatty one?
According to the symptoms you have mentioned, chronic pancreatitis, or IPMN ducts obstruction. Weight loss is just one of such symptoms.
It looks like, sooner or later, you will need a pancreas surgery. Not because of the IPMN, but because of the symptoms including pain.
Mass around the celiac artery must be a lymph node. There is nothing more in this area. And it can not be reached with any biopsy. So only surgical removal of this mass is a possibility to find out its nature.
If your doctor thinks about possible cancer, PET test would be a good idea to rule it out.
IPMN is not a cancer, so can not cause a lesion around celiac artery.
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AS your IPMN is a low risk, I would not even consider this mass as a cancer related. And for sure not pancreas cancer mass. Its impossible for the pancreas cancer to act like that. Especially that you do not have pancreas cancer.
So it might be nothing. Important thing is if the lesion appears in arterial phase of CT. If not, cancer of this site is not the case for sure.
EUS can be done only if this mass is attached to the stomach wall. Otherwise, it may be hard to see it.
How about ERCP (as a pain management). Do you know the ileus reason?
ERCP is not very risky.
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Blood work is fine. Ca 19-9 is also fine. But this really does not prove or rule anything out. We do not use either blood work or CA 19-9 to diagnose any cancer. Just to monitor it. Do you have GGTP and alkaline phosphatase (AP) results?
ERCP is a kind of gastroscopy with pancreatic ducts drainage. It would be a good pain management solution as it is possible to put stent to pancreatic ducts. It is not very risky.
ERCP should help with the pain.
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So your blood work is perfect.
ERCP is a good idea for pain management. Once again. Your IPMN is low risk. So there is no way the mass found in the last tests is anyhow connected with IPMN.
Anxiety can cause diarrhea.
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Blood flow through the pancreas is much more complicated than that. Moreover, if we think about possible metastases from an organ, veins are the source, not arteries. And venous vessels from pancreas go to liver.
Once again, there is no reason the soft tissue is related to the IPMN. However, if the soft tissue causes celiac artery narrowing, abdominal pain can appear because of that. Diarrhea is greatly stimulated by an anxiety for sure. So how about trying antianxiety medicines like Sertaline?
Narrative
Clinical History: 70 year old male found to have soft tissue infiltration along the celiac artery on recent CT scan. COMPARISON: CT abdomen pelvis dated 2/24/2017 and 1/22/2014. TECHNIQUE: Mulipanar multiech echo MR of the abdomen was performed before and after the intravenous administration of 17cc MultiHance. The following sequences were obtained: Three plane localizer, coronal and axial T2 haste, axial true fist, Axiel T2 fat-sat, axial in and out of phase axial DW 1, axial T1 fat-sat, dynamic post contrast axial T1 fat sat during arterial phase one minute, three minutes and coronal. T1 fat-sat. FINDINGS: within the pancreatic head is a 1.5 cm T2 hypericin tense lesion which demonstates no internal enhancement on post contrast imaging. Also identified is a 1 cm lesion within the superior aspect of the pancreatic neck which appears to rise from a nondilated main pancreatic duct. This also demonstrates no internal enhancement. These are favored to represent side branch IPMNs. The remainder of pancreatic parenchyma is normal in signal and morphology. There is no evidence of pancreas divisum. The gallbladder is nondistended. There is no biliary ductal dilation. There is a subtle decrease in signal intensity within the hepatic parenchyma on opposed phase imaging,suggesting mild hepatic steatosis. There is a small T2 hyper intense focus within the periphery of the right hepatic lobe which demonstrates enhancement of post contrast imaging. This may represent a small flash filling hemangioma. a small T2 hyper intense lesion within the left hepatic lobe demonstrates in internal enhancements and is most compatible with a cyst. The major hepatic vessels are patent. The Spleen and adrenal glands appear unremarkable. Several nonenhancing T2 hyper intense lesions within both kidneys are compatible with cortical and parapelvic cysts. The abdominal aorta is normal in caliber. There is mild enhancing soft tissue along the celiac artery. Subtle soft tissue extends extends along the proximal and mid Mesenteric artery as well. This was present on the recent prior CT scan but has increased in extent from the 2014 examination. The arteries do appear to remain patent. A few prominent upper abdominal lymph nodes are also identified. For example, one lymph node to the left of the celiac artery measures 1.3 X 1.0cm. This is unchanged from the prior examination but has mildly increased since 2014. A prominent lymph node superior to the pancreatic neck measuring 1.6 x 1.1 is unchanged dating back to 2014. A small but prominent gastro hepatic lymph node measuring 1.1 is stable as well. These are nonspecific.
IMPRESSION, 1. 1.5 cm hyper intense lesion within the pancreatic head. A 1cm T2 hyper intense lesion is seen within the the superior aspect of the pancreatic neck. This appears to rise from the nondilated pancreatic duct. These lesions demonstrate on internal enhancement on post contrast imaging and are favored to represent side branch IPMNs. 2. mild enhancing soft tissue density along the celiac artery. There is subtle soft tissue density along the proximal mid portions of the superior Mesenteric artery as well. Whike this finding is unchanged from the more recent examination, this has increased since 2014. This is unclear etiology and continued follow up is recommended. There are several prominent gastro hepatic, retro peritoneal, peripancreatic lymph nodes as well. While one lymph node to the left if the celiac artery has mildly increased in size since. 2014, the remainder are not significantly changed. 3. small T2 hyper intense focus within the periphery of the right hepatic lobe demonstrating enhancement on post contrast imaging. This is a small to definitively characterize but may represent a small flas filling hemangioma. A small cyst is present within the left hepatic lobe.4. Bilateral renal cortical and parapelvic cysts.
Your MRI result is fine.
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Here are my thoughts about this MRI:
1. IPMNs are stable. Do not grow. This is very good. No need to do anything with it for sure.
2. The tissue around the celiac artery does not seem to be something serious. This tissue is not hyper intense. This means it is not a cancer related tissue. I would just ignore it.
3. Described lymph nodes are stable through all this years. This means that you just have lymph nodes on that size and its a normal thing for your body. So it can be ignored as well.
The rest is completely fine. There is no sign of any cancer.
It sounds impossible.
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It is hard to advice any trials or hosputals not having diagnosis. In the suspicious area lymph nodes are clearly visible in both CT and MRI. Those lymph nodes enlargement due to metastases is usually also very visible in both tests. And there is no other tissue around it (except fat which is everywhere). So there can not be suspicious tissue there. We can have enlarged lymph nodes. But not some tissue. This sounds impossible.
Either the MRI report is wrong, or you do not have a cancer there.
Do you have the pathologist report?
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Yes, I do understand EUS was done. But do you have a pathologist report(histo-pathology) saying adenocarcinoma? or they are just basing on the EUS image?
In this location, it can be from the stomach (what is very common, but as a lymph nodes involvement). I am just confused how could it be missed in the MRIs. It must have been visible as a lymph node's involvement. Not just as some tissue. That is just not likely for any cancer to grow in this area without large primary tumor.
Lack of pancreatic enzymes can be from a large tumor only! A small one would not affect the pancreas in a visible way. Chronic pancreatitis can do that. And it can cause inflammatory tissue appearance all around the pancreas.
Regards
It may be everything.
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Then really nothing is certain. It can be everything. Hope they took a biopsy during EUS.