Juan J. Castano
University of Texas Rio Grande Valley - Doctors Hospital at Renaissance
An 81 year old woman presented with a 2 week history of epigastric and RUQ pain associated with nausea, jaundice, pruritus, and unintentional weight loss. Labs included AST 114 IU/L, ALT 136 IU/L, ALP 368 IU/L, total bilirubin 7.5 mg/dL with direct bilirubin of 4.5 mg/dL. Abdominal US revealed CBD of 1.39cm. CT abdomen/pelvis with moderate dilation of intrahepatic biliary ducts and dilated CBD with 2.2 cm pancreatic head enhancing soft tissue thickening. Patient underwent EUS, which confirmed presence of a 3.5x2.9 cm mass lesion in the head of the pancreas. Sampling via FNA was performed, followed by ERCP with CBD stent placement. Patient subsequently experienced improvement in overall symptoms. Pathology revealed undifferentiated carcinoma with osteoclast-like giant cells. Patient was not a surgical candidate due to poor nutritional status. She was started on neoadjuvant chemotherapy.