PMC5876285_01
CT abdomen at initial work-up that shows a hypo-attenuated mass in the region of the uncinate process contacting 50% of the superior mesenteric vein, and approximately 25% of the superior mesenteric artery (see arrow) as well as contacting the left renal vein.
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F1
African-American male presented with a 14-day history of abdominal pain and anorexia in the spring of 2008. Abdominal CT scan revealed a 3.4 cm x 3.7 cm x 4.7 cm hypo-attenuated mass in the region of the uncinate process, contacting directly 50  of the superior mesenteric vein and approximately 25  of the superior mesenteric artery as well as contacting the left renal vein (Figure 1).
CT abdomen at restaging following neoadjuvant chemo-radiation therapy showed a 3.3 cm x 3.1 cm mass, decreased from initial size with involvement of the SMA (see arrow) and SMV improved.
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F2
Repeat staging showed a good response with the tumor measuring 3.3 cm x 3.1 cm, and the association of the tumor to the SMV and SMA being improved (Figure 2).
Surgical field at the time of pylorus-preserving pancreaticoduodenectomy in region of the uncinate margin at the superior mesenteric vein (thin arrow), superior mesenteric artery, and inferior vena cava were intraoperative low-kV radiation therapy was administered in retroperitoneal space (thick arrow).
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F3
The patient was taken to surgery and underwent pylorus-preserving pancreaticoduodenectomy (Figure 3).
(A) 1 year post-operative scan showing SMA (see arrow) is clear of disease. (B) 7 year post-operative scan showing renal vein at IVC (see arrow) widely patient and without disease.
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F4
The patient has been followed with repeat three-dimensional imaging at routine intervals (Figure 4).