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Fig. 7. Invasive pancreatic carcinoma invading the retroperitoneum, transverse mesocolon, and greater omentum. a Transaxial image. b Parasagittal reformation (M, mass; P, normal pancreas; S, stomach; TC, transverse colon). The transverse mesocolon (black arrows) provides a pathway for the spread of metastatic disease to the greater omentum (white arrows). Also noted is encasement of the left renal artery and ovarian vein (double arrows)

Fig. 7. Invasive pancreatic carcinoma invading the retroperitoneum, transverse mesocolon, and greater omentum. a Transaxial image. b Parasagittal reformation (M, mass; P, normal pancreas; S, stomach; TC, transverse colon). The transverse mesocolon (black arrows) provides a pathway for the spread of metastatic disease to the greater omentum (white arrows). Also noted is encasement of the left renal artery and ovarian vein (double arrows)

the proximal jejunum just beyond the ligament of Treitz (Fig. 8). Like the gastrocolic ligament, a potential space exists within the transverse mesocolon, due to embryolog-ic fusion of the gastrosplenic ligament with the embry-ologic transverse mesocolon [9]. A less common but important route of spread also exists between the right colon and the periduodenal and peripancreatic nodes via the rightward aspect of the transverse mesocolon (duodeno-colic ligament). This is important because lymphadenopa-thy in the periduodenal and peripancreatic region may herald a right colon cancer when other more common causes of lymphadenopathy in this region are excluded [1].

Three routes of spread between the intraperitoneal viscera and the retroperitoneum are thus provided by three pairs of ligaments. The gastrohepatic and hepatoduodenal

Fig. 8. Incidental pancreatic adenocarcinoma involving the splenic vein (a) was thought to be resectable owing to the lack of extra-pancreatic involvement. At surgery, upon elevation of the transverse colon, the tumor was found to have penetrated the base of the transverse mesocolon and involved the proximal jejunum just beyond the ligament of Treitz (seen in retrospect in (b), arrows)

Fig. 8. Incidental pancreatic adenocarcinoma involving the splenic vein (a) was thought to be resectable owing to the lack of extra-pancreatic involvement. At surgery, upon elevation of the transverse colon, the tumor was found to have penetrated the base of the transverse mesocolon and involved the proximal jejunum just beyond the ligament of Treitz (seen in retrospect in (b), arrows)

ligaments link the liver and lesser curvature of the stomach to the retroperitoneum; the gastrosplenic and splenorenal ligaments link the superior greater curvature of the stomach and spleen to the retroperitoneum and the gastrocolic and transverse mesocolon link the inferior greater curvature of the stomach and transverse colon to the retroperitoneum. The ligamentous pair in which metastatic disease is recognized can suggest the organ of origin, and, in the case of gastric cancer, the location of the primary tumor within the stomach.

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