pls compare the 4 reports named as Report 1, Report 2, Report 3 and report 4.

I used
dashes to mark the separation of each report.
Give me your prognosis and diagnosis by reading these reports. Please use layman
English and also tell me if it's Pancreatic Cancer or is it Pancreatitis?

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Report Name: “Report 1”

Title of Report: “MRI ABDOMEN W/O & W/DYE”
Date: 18 April 2023
Technique: MRI of the abdomen and MRCP study, Multiple pulse sequences were
obtained pre-and post-contrast administration in different scan planes.
Clinical information: Obstructive jaundice
Comparison: None.
FINDINGS: There is marked dilatation of the intrahepatic biliary radicals and the
common bile duct reaching about 2.5 cm in diameters with evidence of a partially
well-defined solid mass lesion is seen obstructing the distal segment of the CBD and
the looking inseparable from the adjoining part of the superior aspect of the
pancreatic head measures about 3.2 x 2.1 cm in diameters eliciting iso-to low signal
in T1, intermediate signal in T2 with faint enhancement after contrast administration.
The gallbladder is markedly distended showing shadow of biliary sludge. The liver is
enlarged in size showing no focal lesions. Normal signal pattern of the spleno-porto-
mesenteric venous axis reflecting patency. The pancreatic body and tail as well as the
pancreatic duct show normal MRI appearance with no solid or cystic lesions. Normal
MRI features of the visualized portions of both kidneys apart from bilateral simple
renal cysts the largest at the right-side measures about 1.6 cm. Spleen of normal size
and respected signal. No retroperitoneal significant nodal enlargement identified. No
ascites. The lower chest cuts shows no definite nodules on MRI basis IMPRESSION: -
360 1. The described MRI findings are highly suggestive of biliary obstruction
associated with marked dilatation of the intra-and extrahepatic biliary radicals as well
as marked distention of the CBD and gallbladder secondary to distal CBD obstructing
mass lesion likely neoplastic in nature for histopathological correlation. 2.
Hepatomegaly. 3. Bilateral small simple renal cysts.

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Report Name: “Report 2”

Title: “CT ABDOMEN W/O DYE”
Date: 21 April 2023
CT ABDOMEN - NON-CONTRAST STUDY Clinical profile: Known case of Obstructive
jaundice.
Technique: Non Contrast CT scan of the abdomen was obtained. The following
observations are made.
Findings: Bilateral minimal pleural effusions with bibasal reticular stranding. Metallic,
self-expanding, CBD Stent in situ, negotiating the distal CBD mass, however the mass
in its entirety cannot be seen optimally in current non-contrast images with CBD
stent in situ. Current caliber of proximal CBD is 12 mm, down from 25 mm, seen on
previously performed MRI. Air within proximal CBD and bilobar biliary radicles, left >
right. Biliary radicular dilatation also decreased as compared with previous MRI. Gall
bladder distension has also decreased as compared with earlier imaging with tiny air
foci within. No radio-opaque calculi. Mild hepatomegaly measuring around 17.5 cm
with diffuse fatty infiltration. No sizeable focal lesions on non- contrast images.
Diffusely bulky pancreas with diffuse peripancreatic stranding with inflammatory
stranding extending into the root of mesentery and transverse mesocolon with
thickening of bilateral perirenal and lateroconal fasciae. Mild peripancreatic fluid,
extending variably into bilateral anterior pararenal & perirenal spaces, pericholecystic
region with extension into perihepatic recesses and bilateral subphrenic regions and
extending caudally along bilateral paracolic gutters into the pelvis. No sizeable
pancreatic lesions detectable on non -contrast images. Necrotic pancreatic foci if any
also cannot be commented upon on non -contrast images. Spleen normal size, shape
and morphology. No sizeable focal lesions on non- contrast images. Bilateral kidneys
normal in positions. No radio-opaque /hydronephrosis. No sizeable uteroadenexal
masses. Opinion -360 1. Bilateral minimal pleural effusions with bibasal reticular
stranding. 2. Metallic, self-expanding, CBD Stent in situ, negotiating the distal CBD
mass, however the mass in its entirety cannot be seen optimally in current non-
contrast images with CBD stent in situ. Current caliber of proximal CBD is 12 mm,
down from 25 mm, seen on previously performed MRI. Air within proximal CBD and
bilobar biliary radicles, left > right. Biliary radicular dilatation also decreased as
compared with previous MRI. Gall bladder distension has also decreased as
compared with earlier imaging with tiny air foci within. No radio-opaque calculi. 3.
Mild hepatomegaly measuring around 17.5 cm with diffuse fatty infiltration. No
sizeable focal lesions on non- contrast images. 4. Diffusely bulky pancreas with
diffuse peripancreatic stranding with inflammatory stranding extending into the root
of mesentery and transverse mesocolon with thickening of bilateral perirenal and
lateroconal fasciae. Mild peripancreatic fluid, extending variably into bilateral anterior
pararenal & perirenal spaces, pericholecystic region with extension into perihepatic
recesses and bilateral subphrenic regions and extending caudally along bilateral
paracolic gutters into the pelvis. No sizeable pancreatic lesions detectable on non -
contrast images.

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Report Name: “Report 3”

Title: "SURGICAL PATHOLOGY REPORT – FINAL”
Date: 20 April 2023
DIAGNOSIS Pancreatic head/neck mass (Al Zahra Private Hospital Dubai, lab ref no.
H-2240-23, dated 20 April 2023): - Atypical glandular infiltrate most consistent with
invasive adenocarcinoma, see comment.
Ahmad Alduaij. MD. FCAP Consultant Pathologist Cleveland Clinic Abu Dhabi
(Electronically signed by) Verified: 02-May-2023 17:20 Asia/Dubai
COMMENT: Thank you for sharing this case in consultation. The histologic sections
show fibroconnective tissue involved by mostly moderately differentiated
adenocarcinoma with mostly glandular, tubular, and focal solid component. Epithelial
cells are focally pleomorphic, cuboidal to columnar with eosinophilic cytoplasm and
round central nuclei and occasional prominent eosinophilic nucleoli. Focal mucin
production and squamoid differentiation are seen. Immunohistochemical stains
performed at NRUCCAD and reveal atpical cells are expressing strongly with CK7,
CK19, MOC31 and CAM5.2. Focal p40 and p63 expression is seen and negative for
TTF-1. The immunomorphologic findings are of cores of fibroconnective tissue with
foci of atypical glandular clusters, focal squamous differentiation and desmoplastic
stroma consistent with mostly moderately to focal poorly differentiated invasive
adenocarcinoma in the proper clinical setting. The differential diagnosis should
include pancreatobiliary in origin among others. Correlation with clinical, endoscopic,
radiologic and laboratory findings is suggested.
Please also review cytology specimen interpretation (10-IN-23-13).
Please do not hesitate to email me if you require any additional information.

MICROSCOPIC DESCRIPTION - See comment & Controls stain appropriately.

GROSS DESCRIPTION:
Specimen received in a formalin filled container labelled with patient's name and
hospital number and clinically designated as " Pancreatic head/neck mass", consist of
multiple pieces of grey-brown, thread-like tissue measuring 1.5 x 1 x 0.1 cm. The
specimen is entirely submitted in one cassette.
PJ /HB

CLINICAL INFORMATION:
Specimen source: Pancreatic head/neck mass
Specimen status (fresh/fixative): Formalin

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Report Name: “Report 4”

Title: "MULTISLICE C.T EXAMINATION OF THE CHEST, ABDOMEN AND PELVIS”
Dated: 07 May 2023
Clinical history: status post ERCP for treatment of biliary obstruction.
Comparison: Last CT dated (Report 2) 21.4.2023 and MRI study (Report 2) 18.4.2023.
A - CHEST without contrast:
Moderate amount of left side pleural effusion with underlying partial compression
lung collapse. Mild right side pleural effusion/thickening seen. Bilateral basal fine
reticulations / atelectatic changes and groundglass veiling. No suspicious lung
nodules or sizable pulmonary masses. No evidence of pericardial sac collections. No
hilar or mediastinal lymph nodes enlargement. Normal CT appearance of the heart.
Prominent pericardial fat is noted. Patent trachea-bronchial tree. Multiple intimal
calcifications are seen at the aortic arch and the coronary arteries with dense
calcifications are seen at the mitral valve.

B: ABDOMEN AND PELVIS with oral and IV contrast:

A known case of distal CBD obstruction underwent ERCP and biliary stenting. There is
progressive changes / transformation of the previously seen peri-pancreatic fat
smudging and inflammatory process into a large sizable irregular encysted fluid
collection surrounding the pancreatic head, body and tail showing high density fluid
content measuring about 23 x 10 x 9 cm in maximum diameters with smudging of
the surrounding fat planes. This encysted fluid collection is seen creeping to the left
hypochondrial region along the greater curvature of the stomach and reaching the
subphrenic space. The pancreatic head, body and tail appears edematous and
swollen with no evidence of enhancing mass lesions. There is progressive changes
regarding the previously seen free fluid is seen at the peri-hepatic, perisplenic and at
the pelvic lesions. Free flow of the orally administrated contrast media through the
stomach, duodenum and other bowel loops with no evidence of intestinal
obstruction. Regressive changes regarding the previously seen dilatation of the
intrahepatic radicles and common bile duct with applied biliary stent showing linear
and focal areas of intra and extrahepatic pneumobilia. Edema of the abdominal wall
is more appreciated at the current study. Liver is average in size showing
homogeneous parenchymal pattern. No focal parenchymal lesions. Patent
homogenously enhanced portal vein and its main divisions Spleen is average in size
showing normal texture. Both kidneys are of normal site and size showing good
excretory function. The right kidney shows a simple cortical cyst measures about 1.5
cm. Normal CT appearance of adrenal glands, aorta and IVC. The urinary bladder
shows no stones, masses or diverticula. Normal CT appearance of the rest pelvic
organs including the uterus and adnexa. No evidence of enlarged retro-crural, porta
hepatis or para-aortic lymph nodes.
CONCLUSION:
1. A known case of distal CBD obstruction underwent ERCP and biliary stenting.
2. There is progressive changes / transformation of the previously seen peri-
pancreatic fat smudging and inflammatory process into a large sizable irregular
encysted fluid collection surrounding the pancreatic head, body and tail creeping to
the left hypochondrial region along the greatercurvature of the stomach and
reaching the subphrenic space, signs are impressive of complicated pancreatitis.
3. Progressive changes regarding the previously seen free fluid is seen at the peri-
hepatic, perisplenic and at the pelvic lesions.
4. Regressive changes regarding the previously seen dilatation of the intrahepatic
radicles and common bile duct with applied biliary stent with linear and focal areas of
intra and extrahepatic pneumobilia. The previously seen distal CBD wall thickening
and underlying obstructive lesion is seen masked by the applied stent and the
surrounding pancreatic inflammatory process.
5. Edema of the abdominal wall is more appreciated at the current study.
6. Moderate amount of left side pleural effusion with underlying partial compression
lung collapse.
7. Mild right side pleural effusion/thickening seen.
8. Bilateral basal fine reticulations / atelectatic changes and groundglass veiling.
9. No suspicious lung nodules or sizable pulmonary masses.