case_images: PMC11788090_01
case_images: Magnetic Resonance Imaging of the Abdomen and Pelvis With Contrast. Yellow arrow: Pancreatic head mass; Red arrow: Transverse colon mass at the prior partial colectomy anastomosis site.
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case_images: PMC11788090_01_cureus-0017-00000076875-i01.jpg
case_images: FIG1
case_images: Magnetic resonance imaging (MRI) of the abdomen with contrast was significant for irregular colonic wall thickening at the anastomosis site, mesenteric soft tissue infiltration extending to the mesenteric root with a necrotic mass, a periduodenal/uncinate mass measuring 6.2 cm x 4.7 cm concerning for metastasis versus duodenal or pancreatic carcinoma, and an indeterminate hypervascular liver lesion in segment 5 measuring 6 mm (Figure 1).
case_images: Diagnostic Colonoscopy Images. Mass was observed during colonoscopy at the site of the previous partial colectomy anastomosis. Images were taken after the biopsy and tattooing of the area.
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case_images: PMC11788090_01_cureus-0017-00000076875-i02.jpg
case_images: FIG2
case_images: A colonoscopy was completed two days after the initial EGD due to poor bowel prep, and significant findings of a villous, fungating, infiltrative, sessile, ulcerated, and partially obstructing mass were identified on gross examination of the ileocolic anastomosis (Figure 2).
case_images: CT Abdomen Pelvis With and Without Contrast. (A) Uncinate process mass abutting the duodenal C-loop with narrowing of the superior mesenteric vein (SMV), measuring 6.9 x 5.2 cm.. (B) Right hemicolectomy anastomosis with a filling defect concerning tumor recurrence, measuring 7.4 x 6.6 cm.
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case_images: FIG3
case_images: A CT of the abdomen and pelvis with and without contrast at the time of the biopsy demonstrated the hypodense mass in the root of the small bowel mesentery possibly arising from the uncinate process of the pancreas and measuring 6.9 x5.2 cm (Figure 3) with abutment and suspected infiltration of the duodenal C-loop.
case_images: Endoscopic, EUS, and Fluoroscopic Images From EDGE Procedure. (A & B) Stable gastrogastric tract with stent in place.. (C) Fine-needle aspiration (FNA) needle being introduced through the gastrogastric tract for pancreatic mass biopsy.. (D) Endoscopic ultrasound (EUS) of the gastrogastric stent tract.. (E) EUS showing the pancreatic mass.. (F & G) Fluoroscopy showing the endoscope approaching and traversing the gastrogastric tract through the lumen-apposing metal-covered stent.. EDGE: Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography
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case_images: FIG4
case_images: Two days later, once the gastrogastric tract had time to mature, the EUS with transgastric FNA was performed to obtain a sample of the pancreatic mass (Figure 4).
case_images: Histology of Pancreatic and Colon Mass. (A) Cytokeratin staining of the pancreatic mass.. (B) Hematoxylin and eosin (H&E) staining of the pancreatic mass.. (C) Signet ring cells were observed on the H&E stain of the pancreatic mass.. (D) Adenoma of the colon on H&E stain.. (E) Mucinous adenoma of the colon.
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case_images: FIG5
case_images: Pathology results of the sample resulted in poorly differentiated adenocarcinoma with signet ring cell features (Figure 5).