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JAMA Surgery Clinical Challenge
October 2014

Pancreatic Neoplasm With Metastatic Workup

Author Affiliations
  • 1University of Oklahoma Health Sciences Center, Oklahoma City
JAMA Surg. 2014;149(10):1087-1088. doi:10.1001/jamasurg.2014.846

A previously healthy 75-year-old woman was referred to our tertiary care center when a workup for abdominal pain and jaundice revealed a duodenal mass. She underwent a metastatic workup. High-resolution computed tomography revealed a 3 × 4-cm circumferential lesion in the second and third portions of the duodenum involving the pancreatic head (Figure 1). Multiple nodules were noted along the peritoneal reflection of the right paracolic gutter. The results of a biochemical analysis were remarkable with a total bilirubin level of 6.8 mg/dL (to convert to micromoles per liter, multiply by 17.104), an aspartate aminotransferase level of 394 U/L, an alanine transaminase level of 746 U/L, and an alkaline phosphatase level of 1146 U/L (to convert the last 3 analytes to microkatals per liter, multiply by 0.0167). Her medical history was significant for hypertension and a previous laparoscopic cholecystectomy approximately 6 years ago.

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