Authors
Abdullah Farooq, Jazeela Saud, Henok E Sisay, Husnain Hanif, Muhammad Subhan, Alwaleed Alfadhli
Published in
Cureus. Volume 18. Issue 9. Pages e116897. Epub Sep 25, 2026.
Abstract
Pancreatic adenocarcinoma is one of the deadliest types of cancer, with a very gloomy prognosis, especially if the cancer is at an advanced stage at the time of diagnosis. Among young adults, the vague symptoms that are usual with pancreatic cancer can be confused with those of a benign biliary condition, so the diagnosis is often late. It may be quite challenging to recognize that a bile duct obstruction with jaundice is due to a periampullary tumor, which is similar to a bile duct stone, unless one suspects it very strongly. We present the case of a 38-year-old man who suffered from increasing abdominal pain, significant weight loss, and obstructive jaundice. An initial triphasic CT showed the presence of dilated intrahepatic biliary ducts and a dilated common bile duct (CBD) with duodenal spots that were thought to be passed gallstones. At the same time, a liver lesion was identified as a probable hemangioma. The diagnosis was postponed even though the liver function tests were progressively deteriorating (total bilirubin increased to 10.4 mg/dL and alkaline phosphatase to 1394 U/L). Further endoscopic retrograde cholangiopancreatography (ERCP) revealed a distal CBD stricture without stones; therefore, a plastic stent was placed. No tissue sampling was obtained during ERCP. Five months later, an extremely high carbohydrate antigen 19-9 (CA 19-9) (>500 U/mL) and a repeat triphasic CT showed a 43 × 45 mm pancreatic head tumor with liver and lung metastases. These findings supported a clinical-radiological diagnosis of metastatic pancreatic malignancy, presumed pancreatic adenocarcinoma; histopathological confirmation of the pancreatic or hepatic lesions was not obtained. Subsequent ascitic fluid cytology showed malignant cells consistent with adenocarcinoma, but immunocytochemistry was not available, so the pancreatic primary was not independently established. This case highlights that if a biliary stricture occurs without a stone that can be identified in a patient with progressive obstructive jaundice, the stricture should be considered malignant until demonstrated otherwise. Early obtaining of tissue for diagnosis and appropriate use of tumor markers as supportive rather than definitive tests are the main elements to steer clear of a long diagnostic odyssey.
PMID:
42928765
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.
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