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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{YD}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 55 year old African-American man presents to the physician's office complaining of abdominal fullness, unintentional weight loss, and depression. The patient's medical history is significant for heavy smoking. Initial work-up shows elevation of tumor marker CA19-9. Additional imaging reveals a large mass at the head of the pancreas. Biopsy confirms the diagnosis of pancreatic cancer. Which of the following findings is most likely to be additionally present in this patient?
|Prompt=A 55-year-old African-American man presents to the physician's office complaining of pruritus, unintentional weight loss, and depression. The patient's history is significant for heavy smoking for the past 30 years. Physical examination reveals marked jaundice and icterus. Abdominal CT scan demonstrates a large pancreatic head mass abutting the superior mesenteric artery. Which of the following findings may be present in this patient?
|Explanation=The patient is presenting with pancreatic cancer, which is suggested by the patient's history. Abdominal fullness, weight loss, and occasionally abdominal pain that radiates to the back are all symptoms of pancreatic cancer. The patient's tobacco use is an important risk factor for the development of pancreatic cancer. It is important to remember also that pancreatic cancer is classically strongly associated with major depression. Typically, tumor marker CA19-9 is elevated in pancreatic cancers.
|Explanation=The patient's symptoms and signs are classical findings of pancreatic cancer. One of the most lethal human cancers, it is often detected late in the course of disease due to its silent nature. Important risk factors include smoking, male gender, family history, chronic pancreatitis, and ethnicity (African-Americans). The most important pathways involved in the tumorigenenis of pancreatic adenocarcinoma include products of the KRAS, RB1, and TP53 genes. A tri-phasic pancreatic-protocol CT is the initial diagnostic test of choice for patients with suspected pancreatic cancer. An important complication observed in pancreatic cancer patients is Trousseau syndrome or migratory thrombophlebitis. Trousseau syndrome is defined as either spontaneous recurrence of migratory venous thromboses, or arterial emboli by non-bacterial endocarditis in patients with cancer.
 
Pancreatic cancer is considered a hypercoagulable state that is associated with thromboembolic diseases, such as migratory thrombophlebitis. Trousseau syndrome is defined as the presence of cancer and either spontaneous recurrence or migratory venous thromboses, or arterial emboli by non-bacterial endocarditis, or both.
 
Educational Objective:
Pancreatic cancer is considered a hypercoagulable state that is associated with migratory thrombophlebitis.
 
Reference:
Callander N, Rapaport SI. Trousseau's syndrome. West J Med. 1993;158(4):364-71.
 


|AnswerA=Esophageal strictures
|AnswerA=Esophageal strictures
|AnswerAExp=Esophageal strictures are not associated with pancreatic cancers. They are associated with Crohn's disease, lye ingestion, and GERD  
|AnswerAExp=Esophageal strictures are not associated with pancreatic cancers. They are associated with Crohn's disease, lye ingestion, and GERD
|AnswerB=Migratory thrombophlebitis
|AnswerB=Migratory thrombophlebitis
|AnswerBExp=Migratory thrombophlebitis or Trousseau syndrome is associated with pancreatic cancer.
|AnswerBExp=Migratory thrombophlebitis or Trousseau syndrome is associated with pancreatic cancer.
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|AnswerE=Eosinophilic infiltration in the liver
|AnswerE=Eosinophilic infiltration in the liver
|AnswerEExp=Eosinophilic infiltration in the liver on biopsy is frequently seen in several conditions, such as autoimmune hepatitis and drug-induced liver injury. Nonetheless, liver eosinophilia is not diagnostic in either conditions.
|AnswerEExp=Eosinophilic infiltration in the liver on biopsy is frequently seen in several conditions, such as autoimmune hepatitis and drug-induced liver injury. Nonetheless, liver eosinophilia is not diagnostic in either conditions.
|EducationalObjectives=Pancreatic cancer is considered a hypercoagulable state associated with migratory thrombophlebitis or Trousseau syndrome.
|References=Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet. 2011;378(9791):607-20.<br>
Callander N, Rapaport SI. Trousseau's syndrome. West J Med. 1993;158(4):364-71.
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=pancreatic, pancreas, cancer, carcinoma, abdominal, fullness, weight, loss, CA19-9, migratory, thrombophlebitis, trousseau, syndrome, hypercoagulable, state
|WBRKeyword=Pancreatic cancer, Pancreatic adenocarcinoma, Migratory thrombophlebitis, Trousseau syndrome, Hypercoagulable state
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:44, 28 October 2020
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Gastrointestinal
Prompt [[Prompt::A 55-year-old African-American man presents to the physician's office complaining of pruritus, unintentional weight loss, and depression. The patient's history is significant for heavy smoking for the past 30 years. Physical examination reveals marked jaundice and icterus. Abdominal CT scan demonstrates a large pancreatic head mass abutting the superior mesenteric artery. Which of the following findings may be present in this patient?]]
Answer A AnswerA::Esophageal strictures
Answer A Explanation AnswerAExp::Esophageal strictures are not associated with pancreatic cancers. They are associated with Crohn's disease, lye ingestion, and GERD
Answer B AnswerB::Migratory thrombophlebitis
Answer B Explanation AnswerBExp::Migratory thrombophlebitis or Trousseau syndrome is associated with pancreatic cancer.
Answer C AnswerC::Gastroesophageal reflux disease (GERD)
Answer C Explanation AnswerCExp::GERD is not associated with pancreatic cancer.
Answer D AnswerD::Prolonged prothrombin time
Answer D Explanation AnswerDExp::Prolonged prothrombin time is a sign of anti-coagulation. Pancreatic cancer is, in converse, a pro-thrombotic state.
Answer E AnswerE::Eosinophilic infiltration in the liver
Answer E Explanation AnswerEExp::Eosinophilic infiltration in the liver on biopsy is frequently seen in several conditions, such as autoimmune hepatitis and drug-induced liver injury. Nonetheless, liver eosinophilia is not diagnostic in either conditions.
Right Answer RightAnswer::B
Explanation [[Explanation::The patient's symptoms and signs are classical findings of pancreatic cancer. One of the most lethal human cancers, it is often detected late in the course of disease due to its silent nature. Important risk factors include smoking, male gender, family history, chronic pancreatitis, and ethnicity (African-Americans). The most important pathways involved in the tumorigenenis of pancreatic adenocarcinoma include products of the KRAS, RB1, and TP53 genes. A tri-phasic pancreatic-protocol CT is the initial diagnostic test of choice for patients with suspected pancreatic cancer. An important complication observed in pancreatic cancer patients is Trousseau syndrome or migratory thrombophlebitis. Trousseau syndrome is defined as either spontaneous recurrence of migratory venous thromboses, or arterial emboli by non-bacterial endocarditis in patients with cancer.

Educational Objective: Pancreatic cancer is considered a hypercoagulable state associated with migratory thrombophlebitis or Trousseau syndrome.
References: Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet. 2011;378(9791):607-20.
Callander N, Rapaport SI. Trousseau's syndrome. West J Med. 1993;158(4):364-71.]]

Approved Approved::Yes
Keyword WBRKeyword::Pancreatic cancer, WBRKeyword::Pancreatic adenocarcinoma, WBRKeyword::Migratory thrombophlebitis, WBRKeyword::Trousseau syndrome, WBRKeyword::Hypercoagulable state
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