57-year-old male with well-differentiated neuroendocrine tumor in the liver. ABDOMEN:LIVER, BILIARY TRACT: There is a circumscribed, enhancing mass in hepatic segment four measuring 7.6 x 7.6 cm. Tumor replaces the right and left portal veins, main portal vein extending into the confluence of the SMV and splenic vein. There is cavernous transformation of the portal vein with numerous porta hepatis varices, gastric varices and splenic varices.The gallbladder is normal in appearance. The cystic duct is normal in caliber. There is mild intrahepatic and proximal extrahepatic ductal dilatation with compression on the common bile duct by tumor thrombus from the portal vein.SPLEEN: Splenomegaly measuring 17 cm.PANCREAS: The main pancreatic duct is normal in caliber. There are small T2 hyperintense foci in the uncinate process and body of the pancreas. The focus in the body of the pancreas demonstrates clear communication with the main pancreatic duct compatible with a side branch IPMN. The largest T2 hyperintense lesion measures 8 mm in the distal body of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged porta hepatis lymph node measuring 2.8 x 2.1 cm (series 201, image 26).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Circumscribed, avidly enhancing hepatic segment 4 lesion as described above, consistent with patient's biopsy-proven metastatic neuroendocrine tumor. Tumor thrombus also replaces the right and left portal veins, main portal vein, and extends into the confluence of the SMV and splenic vein. Cavernous transformation of the portal vein and numerous varices are present. Metastatic adenopathy present.2.Evaluation of pancreas is somewhat limited due to mass effect from aforementioned extensive tumor thrombus and due to paucity of intra-abdominal fat. Within these limitations, no suspicious pancreatic masslesion evident. No pancreatic ductal dilatation.3.Cystic lesions within the uncinate process and body of the pancreas are felt to represent side-branch type IPMNs.