A 68-year-old man presents to his physician with a 3-month history of weight loss, fatigue, and progressive jaundice. His medical history is significant for type 2 diabetes mellitus and a 40-pack-year smoking history. Medications include metformin and atorvastatin. Temperature is 36.9°C (98.4°F), blood pressure is 126/78 mm Hg, pulse is 82/min, and respiratory rate is 14/min. Physical examination reveals scleral icterus and a palpable, nontender gallbladder. Laboratory studies demonstrate elevated bilirubin and alkaline phosphatase levels. CT imaging identifies a mass in the head of the pancreas.
Which of the following is the most likely diagnosis?
The correct answer is:
C: Pancreatic adenocarcinoma.
This patient has painless obstructive jaundice, weight loss, a smoking history, and a pancreatic head mass. A palpable nontender gallbladder (Courvoisier sign) is highly suggestive of malignant biliary obstruction. Pancreatic adenocarcinoma commonly presents late and carries a poor prognosis.
Answer choice A: Acute cholangitis, is incorrect.
Cholangitis typically presents with fever, right upper quadrant pain, and jaundice rather than progressive painless jaundice.
Answer choice B: Chronic pancreatitis, is incorrect.
Chronic pancreatitis usually presents with chronic abdominal pain and exocrine insufficiency rather than a pancreatic mass causing painless jaundice.
Answer choice D: Pancreatic pseudocyst, is incorrect.
Pseudocysts generally occur after pancreatitis and do not typically cause progressive constitutional symptoms.
Answer choice E: Primary sclerosing cholangitis, is incorrect.
Primary sclerosing cholangitis (PSC) causes chronic cholestatic liver disease but would not explain a discrete pancreatic mass.
Key Learning Point
Painless obstructive jaundice and a pancreatic head mass should raise strong suspicion for pancreatic adenocarcinoma.
