A Diagnostic Dilemma of Pancreatic Adenocarcinoma: The Duct Cut-off Sign

Abstract

Pancreatic cancer carries one of the worst prognoses in the United States. It is the fourth leading cause of cancer-related death in the United States and second after colorectal cancer in digestive system cancer-related death. Early detection is the key to improving its prognosis. Surgical resection is the only curative treatment, but even after margin-negative resection, the 5-year survival rate is still 30%. The following case presents a fascinating diagnosis of pancreatic cancer. Despite an initial diagnosis of pancreatitis, negative cytology, tumor markers, and imaging suggestive of intraductal papillary mucinous neoplasm (IPMN), this patient underwent surgical resection that later revealed pancreatic adenocarcinoma of the tail. This article highlights certain imaging modalities and characteristics that are essential in the diagnosis of pancreatic adenocarcinoma, in an effort to guide management of similar cases, with hope it leads to better outcomes.