WBR0796
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| 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. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Pancreatic cancer, WBRKeyword::Pancreatic adenocarcinoma, WBRKeyword::Migratory thrombophlebitis, WBRKeyword::Trousseau syndrome, WBRKeyword::Hypercoagulable state |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |