Male; 74 years old. Reason: metastatic renal cell carcinoma to the pancreatic head and R nephrectomy bed, MRI for radiation planning (SBRT). ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation. Cholelithiasis. No suspicious focal hepatic lesions. SPLEEN: No significant abnormality noted.PANCREAS: Status post resection of pancreatic body and tail. Heterogeneously enhancing mass appears to originate from the pancreatic uncinate process and demonstrates increased signal on diffusion weighted imaging and measures 2.9 x 2.2 cm (series 601, image 182). There is mild resultant pancreatic ductal dilatation to 3 mm, slightly progressed since the CT from December 2014. ADRENAL GLANDS: No significant abnormality noted in left adrenal gland. Right adrenal gland not visualized. KIDNEYS, URETERS: Status post right nephrectomy. T2 hyperintense, enhancing mass in the right nephrectomy bed compresses and also appears to invade the adjacent IVC, measuring 2.9 x 2.5 cm (series 901, image 30). Given that soft tissue material within the IVC demonstrates heterogeneous enhancement, tumor thrombus is favored over bland thrombus (series 1201, image 623). Left kidney is unremarkable aside from scattered subcentimeter cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Circumscribed lesion measuring 3.1 x 2.5 cm in the subcutaneous soft tissues of the left lateral pelvic wall. This lesion appears to contain fat on T2 weighted sequences and on prior CT; findings are suggestive of a region of fat necrosis (series 1101, image 27).
1.Heterogeneously enhancing mass in the right nephrectomy bed which appears to compress and invade the adjacent IVC, compatible with recurrent tumor and probable tumor thrombus. 2.Additional enhancing mass in/near the pancreatic uncinate process, indicative of metastatic disease. Mildly worsening pancreatic ductal dilatation and upstream intrahepatic biliary ductal dilatation are also identified. 