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JAMA Surgery Clinical Challenge
August 2015

Diarrhea, Weight Loss, and an Ampullary Mass

Author Affiliations
  • 1Montefiore Einstein Center for Cancer Care, Department of Surgery, Albert Einstein College of Medicine, New York, New York
JAMA Surg. 2015;150(8):809-810. doi:10.1001/jamasurg.2015.0411

A man in his 50s with a history of hypercholesterolemia and type 2 diabetes mellitus was referred for diarrhea (5-6 times per day) and a 27-kg weight loss in the preceding 5 months. The patient did not have abdominal pain, nausea, vomiting, or a history of abdominal surgical procedures and did not use alcohol or tobacco.

On physical examination, the patient’s abdomen was soft, nontender, and nondistended, with no palpable masses, and he did not appear jaundiced. Results of laboratory testing demonstrated a carbohydrate antigen 19-9 level of less than 1 U/mL and a carcinoembryonic antigen level of 6.0 ng/mL (to convert to micrograms per liter, multiply by 1.0). A duodenal mass was found using esophagogastroduodenoscopy and biopsies were taken. To further evaluate the lesion, the patient underwent a computed tomographic scan of the abdomen and pelvis with contrast dye (Figure 1).

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