PMC5656292_01
(A, B) 1.8 cm water attenuation rounded lesion in neck of pancreas anterior to splenic-portal confluence. (A) Along right lateral aspect of this lesion in adjacent cuts is a subtle hypoattenuation involving the pancreatic parenchyma, which extends near the hepatic artery (which is almost completely encased) (B) and a partially occlusive portal vein thrombus.
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A computed tomography of the abdomen revealed a 1.8 cm hypoattenuating lesion in the neck of the pancreas anterior to the portal confluence and encasing the adjacent portion of the hepatic artery (Fig. 1A, B).
Endoscopic ultrasound. Isoechoic, heterogeneous, mixed solid, and cystic mass in the neck of the pancreas. Largest dimensions 23 mm by 21 mm.
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An endoscopic ultrasound (EUS) revealed an isoechoic, heterogeneous, mixed solid, and cystic mass in the neck of the pancreas, which measured 23 mm by 21 mm (Fig. 2).
(A) Fine needle aspiration with cytopathology revealed reactive appearing acinar cells and no evidence of a malignant neoplasm. (B) Resection of the pancreatic lesion revealed the presence of a pancreatic-portal fistula with associated thrombus (red arrow). (C, D) This finding was confirmed histologically with communication of the portal vein and adjacent pancreatic parenchyma. The fistula was characterized by hemorrhage (black arrows) and surrounding fibrosis (blue arrows) with residual pancreatic parenchyma at the periphery.
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Fine needle aspiration (FNA) with subsequent cytopathology revealed benign-appearing, reactive acinar cells (Fig. 3A). The surgical specimen did not demonstrate a malignant process, but rather a pancreatic-portal vein fistula (Fig. 3B) with an associated thrombus. These findings were confirmed histologically and showed a clear communication between the pancreatic parenchyma and portal vein with associated hemorrhage and fibrosis (Fig. 3C, D).