A former smoker presents with painless jaundice and a non-tender palpable RUQ mass. What is most likely diagnosis?

A former smoker presents with painless jaundice and a non-tender palpable RUQ mass. What is most likely diagnosis?

• A. Hepatocellular carcinoma
• B. Cholangiocarcinoma
• C. Gallbladder cancer
• D. Pancreatic cancer

Answer: (D)

Painless jaundice with a non-tender palpable right upper quadrant mass points to malignant obstruction of the biliary system, most often from a tumor in the head of the pancreas. A pancreatic head lesion compresses the distal common bile duct, causing conjugated hyperbilirubinemia and obstructive jaundice. The resulting bile backup distends the gallbladder, which can be palpated as a non-tender RUQ mass—this is the Courvoisier sign. A history of smoking increases the likelihood of pancreatic adenocarcinoma. Hepatocellular carcinoma would more typically present with a liver-origin mass and signs of liver disease; cholangiocarcinoma can cause obstructive jaundice but the classic presentation with a distended, non-tender gallbladder due to distal bile duct obstruction most strongly suggests pancreatic head cancer. Gallbladder cancer usually presents with gallbladder-specific symptoms and stones-related risk factors.

Painless jaundice with a non-tender palpable right upper quadrant mass points to malignant obstruction of the biliary system, most often from a tumor in the head of the pancreas. A pancreatic head lesion compresses the distal common bile duct, causing conjugated hyperbilirubinemia and obstructive jaundice. The resulting bile backup distends the gallbladder, which can be palpated as a non-tender RUQ mass—this is the Courvoisier sign. A history of smoking increases the likelihood of pancreatic adenocarcinoma.

Hepatocellular carcinoma would more typically present with a liver-origin mass and signs of liver disease; cholangiocarcinoma can cause obstructive jaundice but the classic presentation with a distended, non-tender gallbladder due to distal bile duct obstruction most strongly suggests pancreatic head cancer. Gallbladder cancer usually presents with gallbladder-specific symptoms and stones-related risk factors.