Differential Diagnosis for 88 year old male with 1.9 cm pancreatic head lesion
Single most likely diagnosis
- Pancreatic adenocarcinoma: This is the most common type of pancreatic cancer, and the patient's age, location of the lesion (pancreatic head), and symptoms (abdominal pain, elevated liver enzymes, and pancreatitis) are all consistent with this diagnosis. The size of the lesion (1.9 cm) is also concerning for malignancy.
Other Likely diagnoses
- Pancreatic neuroendocrine tumor (PNET): Although less common than pancreatic adenocarcinoma, PNETs can present with similar symptoms and imaging findings. The patient's age and location of the lesion make this a possible diagnosis.
- Chronic pancreatitis with a pseudocyst: The patient's symptoms of abdominal pain and pancreatitis could be due to chronic pancreatitis, and the 1.9 cm lesion could represent a pseudocyst.
- Ampullary cancer: The location of the lesion in the pancreatic head raises the possibility of ampullary cancer, which is a type of cancer that arises from the ampulla of Vater.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Pancreatic lymphoma: Although rare, pancreatic lymphoma can present with similar symptoms and imaging findings, and would require prompt treatment.
- Metastatic disease to the pancreas: The patient's age and symptoms could be consistent with metastatic disease to the pancreas from another primary site, such as the lung or breast.
Rare diagnoses
- Solid pseudopapillary neoplasm (SPN): This is a rare type of pancreatic tumor that is typically seen in younger women, but can occur in older men.
- Pancreatic sarcoma: This is a rare type of cancer that arises from the connective tissue of the pancreas.
- Intraductal papillary mucinous neoplasm (IPMN): This is a rare type of pancreatic tumor that can present with similar symptoms and imaging findings, but is typically seen in younger patients.