RT Journal
A1 Benjamin M, Gopal G, Ronald R. S
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD January 1
VO 145
IS 1
SP 101
OP 101
DO 10.1001/archsurg.2009.230-a
UL http://dx.doi.org/10.1001/archsurg.2009.230-a
AB 
A 59-year-old white man had presented 19 years previously with renal cell carcinoma of the right kidney and had a radical nephrectomy. Six years later a surveillance computed tomographic scan revealed an isolated pulmonary metastasis, and he had a left pneumonectomy. Nineteen years after his initial resection, he presented to the emergency department with an episode of gastroenteritis; a computed tomographic scan at that time showed a mass in the body of the pancreas, confirmed using magnetic resonance imaging and endoscopic ultrasound with biopsy. There was no evidence of major vasculature invasion, and results of further metastatic evaluation were negative. The patient was taken to the operating room for a distal pancreatectomy and splenectomy. During exploration, a resectable mass was identified in the body and tail of the pancreas, and there was no evidence of further metastatic disease.