The dyspeptic disco dancer

Abstract

A 25-year-old girl, who enjoys regular visits to the local disco, presented early in 1987 with hepatomegaly and a mass arising from the pelvis. She was otherwise fit and normal. Her previous medical history was very interesting. Seven years previously she had developed painless jaundice. Laparotomy at another hospital revealed a mass in the pancreatic head and a Whipple's operation was performed. Histology at that time was said to be carcinoma of the pancreas, and she and her parents were informed of the poor prognosis to be expected. She remained well however for the next 3 years before returning to the same hospital because of recurrent nocturnal epigastric pain and an epigastric mass. Obstruction by recurrent tumour was diagnosed but at laparotomy widespread metastases were found in the liver. The stomach was not obstructed but an anastomotic ulcer was found. It was considered that she had an “inoperable tumour” and further surgery was not performed. Her family doctor treated her with ranitidine which gave good symptomatic relief. The presence of multiple hepatic metastases, with histology similar to that found previously, was taken to suggest an advanced stage of the disease with a poor prognosis, although she had already survived 3 years.