Metastatic Pancreatic Adenocarcinoma Presenting as a Klatskin Tumor.

Cholangiocarcinoma is a rare clinical entity representing approximately 2% of all cancers diagnosed. More than 65% of these tumors can present at the bifurcation of the hepatic duct and are known as Klatskin tumors. Pancreatic cancer is among the top 5 leading causes of cancer death, and it usually presents at an advanced stage with metastasis commonly seen in the liver. We report a patient with established pancreatic adenocarcinoma who presented with an obstructing mass at the hepatic duct bifurcation without any prior history of biliary tract disease. This represents a new diagnosis of either intracholedochal metastatic tumor or a new diagnosis of cholangiocarcinoma found at the hepatic duct bifurcation without liver involvement in the setting of pancreatic cancer, suggesting metachronous cholangiocarcinoma with pancreatic adenocarcinoma.

26-Year-Old Survivor of Kasai Procedure With Native Liver.

A 26-year old woman with history of congenital biliary atresia and Kasai procedure as a newborn presented with recurrent nausea and abdominal pain. Physical examination showed anicteric sclera and tender right upper quadrant. Elevated liver function tests suggested obstruction and hepatitis. Percutaneous transhepatic cholangiogram showed generalized ductal dilation, innumerable intrahepatic bile duct stones, and multiple filling defects. No anastomotic stenosis was noted. The patient was treated for acute symptoms and referred to a liver transplant center. Long-term survivors of the Kasai procedure with a native liver are rare, and this represents the third known U.S. case in the literature.

Colon cancer presenting as a testicular metastasis.

We report a case of a 43-year-old male who initially presented with intermittent testicular pain as the first sign of metastatic stage IV colon cancer. Physical examination revealed a normal penis, scrotum and testes. Magnetic resonance imaging (MRI) of pelvis showed an irregular 3 cm mass of the spermatic cord and right radical inguinal orchiectomy was performed. The pathological diagnosis was metastatic adenocarcinoma. In conclusion, even though metastases to the testes are rare, they should be considered in clinical practice especially in older men who present with a testicular mass or discomfort.

Eosinophilic Pancreatitis Diagnosed With Endoscopic Ultrasound.

Eosinophilic pancreatitis (EP) is a rare clinical entity, and few cases have been reported. It usually presents on imaging as a pancreatic mass leading to common bile duct obstruction and jaundice. Since it can mimic a malignancy, eosinophilic pancreatitis is often diagnosed after "false positive" pancreatic resections. To our knowledge, we report the only known case of EP in which the diagnosis was made by fine needle aspiration and core biopsy of the pancreas during EUS, sparing the patient a surgical resection. After a steroid course, there was improvement of clinical symptoms.