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Special Feature
January 2010

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: Yale University School of Medicine, New Haven, Connecticut.

Arch Surg. 2010;145(1):101. doi:10.1001/archsurg.2009.230-a

A 59-year-old white man had presented 19 years previously with renal cell carcinoma of the right kidney and had a radical nephrectomy. Six years later a surveillance computed tomographic scan revealed an isolated pulmonary metastasis, and he had a left pneumonectomy. Nineteen years after his initial resection, he presented to the emergency department with an episode of gastroenteritis; a computed tomographic scan at that time showed a mass in the body of the pancreas, confirmed using magnetic resonance imaging and endoscopic ultrasound with biopsy. There was no evidence of major vasculature invasion, and results of further metastatic evaluation were negative. The patient was taken to the operating room for a distal pancreatectomy and splenectomy. During exploration, a resectable mass was identified in the body and tail of the pancreas, and there was no evidence of further metastatic disease.

The picture depicts part of the removed specimen (Figure 1).

Figure 1.
Tissue chain extracted from main pancreatic duct using a Fogarty balloon catheter.

Tissue chain extracted from main pancreatic duct using a Fogarty balloon catheter.

What Is the Diagnosis?

A. Splenic artery

B. Renal cell metastasis extracted from main pancreatic duct

C.Ascaris lumbricoides, intestinal tapeworm

D. Intraductal papillary mucinous neoplasm cast