69 y.o. Man with vogue upper abdominal pain for several month without any weight loss, vomiting, constipation or other complains send to do an abdominal CT.
(a) Pre-contrast enhancement axial CT image of the upper abdomen shows an ill-defined mass with a small calcification at the tail of the pancreas (arrow), isodense to normal pancreatic parenchyma.
(b) Dynamic CT enhancement axial image in the arterial phase at the same level shows enhancement of the mass (arrow).
(c) A contrast enhanced axial CT image in the porto-venous phase at a higher level than figures 1a and 1b shows multiple hypodense lesions in both lobes of the liver representing hemorrhage in the metastatic liver lesions (arrow).
What is the most likely diagnosis?
A. Pancreatic adenocarcinoma.
B. Serous cystadenoma
C. Pancreatic neuroendocrine tumour (Islet cell tumour)
D. Mucinous cystadenocarcinoma