Abstract
A 64-year-old diabetic woman presented with a 1-week history of abdominal pain and cholestatic jaundice. Her laboratory tests showed: leukocyte count 7.2 × 109/L (normal range 3.5 – 10.5 × 109/L), total bilirubin 10.5 μg/dL (0.1 – 1.0 μg/dL), aspartate aminotransferase (AST) 337 U/L (12 – 31 U/L), alanine aminotransferase (ALT) 624 U/L (9 – 29 U/L), alkaline phosphatase 724 U/L (50 – 130 U/L), lipase 24 U/L (10 – 73 U/L), CA 19 – 9 28 units/mL (< 55 units/mL) and IgG4 137 mg/dL (8 – 140 mg/dl). Abdominal computed tomography revealed a pancreatic head mass that was encasing the portal vein and common hepatic artery but sparing the superior mesenteric artery, with evidence of peripancreatic and portal lymphadenopathy; there was no evidence of hepatic or splenic involvement ([Fig. 1]). Her chest radiograph was normal. Endoscopic ultrasound (EUS) revealed a 4.3-cm, echo-poor pancreatic head mass and a 1.4-cm (short axis) peripancreatic lymph node ([Fig. 2], [3]). EUS-guided fine-needle aspiration (EUS-FNA) of the pancreatic head and of the peripancreatic lymph node was performed.
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