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Woman With a Pancreatic Mass

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BACKGROUND
This 62-year old woman was referred for a neck swelling. Her surgical history includes cholecystectomy performed 32 years ago for gallbladder disease. She also underwent subtotal thyroidectomy 15 years ago to treat a multinodular goiter. Histologic analysis of the specimen at that time had shown a microscopic focus of follicular thyroid carcinoma. The patient also underwent right nephrectomy for renal cell carcinoma 10 years ago, when she presented with hematuria.

Physical examination reveals a 5 X 3-cm swelling in the right supraclavicular fossa. Fine-needle aspiration of the swollen area is attempted, but the sample is deemed insufficient for cytologic diagnosis. CT scans of the abdomen (shown here) show a 7.5-cm pancreatic mass and a 7-cm left renal mass.

Hint
Metastases

Author:	Ali Nawaz Khan, MBBS, FRCP, FRCS, FRCR, Lecturer, Department of Diagnostic Radiology, Faculty of Medicine, University of Manchester, and Iqbal Rizal-Wong, MBChB, Senior House Officer, Hepatobiliary Unit, North Manchester General Hospital NHS Trust, UK


eMedicine Editor:	Sat Sharma, MD, Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine

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