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Pancreatic herniation: a large pancreatic mass concealed within the intrathoracic cavity
  1. Abhinav Karan1,
  2. Amy Kiamos1,
  3. Anthony Stack2 and
  4. Bharatsinh Gharia2
  1. 1Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
  2. 2Hematology and Oncology, University of Florida College of Medicine—Jacksonville, Jacksonville, Florida, USA
  1. Correspondence to Dr Abhinav Karan; abhinav.karan{at}


Cancer of unknown primary is a challenging entity. We present an elderly woman with metastatic cancer of unknown primary despite comprehensive imaging and immunohistochemical analysis. Based on a thorough history, a gastrointestinal source was suspected and a diagnosis of pancreatic cancer concealed within a type IV hiatal hernia was made using multimodal imaging. On review of prior imaging, due to the highly complex anatomy within our patient’s hiatal hernia, the pancreatic mass was retroactively noted. While initial imaging may detect metastatic disease, identifying the primary malignancy requires a thorough history and physical examination, multimodal imaging where malignancy is suspected, and immunohistochemical analysis of metastatic deposits. Herniation of pancreatic cancer has not been previously described in the literature and serves as an important reminder of the importance of multimodal imaging in patients with significantly complex anatomy.

  • Pancreas and biliary tract
  • General practice / family medicine
  • Pancreatic cancer
  • Screening (oncology)
  • Oesophagus

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  • Contributors AbK and AK served to draft and design the submitted manuscript. AS and BG served roles in supervising and editing the submitted manuscript. All authors played a role in patient care and the acquisition of imaging.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.