WBR0796
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| 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 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?]] |
| 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 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.
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. |
| Approved | Approved::No |
| Keyword | WBRKeyword::pancreatic, WBRKeyword::pancreas, WBRKeyword::cancer, WBRKeyword::carcinoma, WBRKeyword::abdominal, WBRKeyword::fullness, WBRKeyword::weight, WBRKeyword::loss, WBRKeyword::CA19-9, WBRKeyword::migratory, WBRKeyword::thrombophlebitis, WBRKeyword::trousseau, WBRKeyword::syndrome, WBRKeyword::hypercoagulable, WBRKeyword::state |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |