title: Obstructive jaundice due to a pancreatic mass: a rare presentation of acute lymphoblastic leukaemia in an adult.
abstract: BACKGROUND
  To highlight a rare presentation of acute lymphoblastic leukaemia.
  
  
  METHODS
  A 39-year-old man presented with a 4 month history of weight loss and a 6 week history of upper abdominal pain radiating to the back with nausea and vomiting. Liver function tests showed an obstructive picture, full blood count was normal and on computerised tomography there was diffuse enlargement of the pancreas, with dilatation of the common bile duct and intra hepatic biliary radicles. Four weeks after presenting, the white cell count became elevated with blasts on the blood film and bone marrow biopsy revealed a precursor B cell acute lymphoblastic leukaemia. After induction chemotherapy his jaundice resolved, the pancreatic mass reduced in size and he is now in a complete remission.
  
  
  CONCLUSIONS
  Acute lymphoblastic leukaemia may mimic common causes of a pancreatic mass such as adenocarcinoma and should be considered as part of the differential diagnosis when atypical features are present.
authors.affiliation: Department of HPB and Transplant, Ground Floor, Lincoln Wing, St James's University Hospital, Leeds, United Kingdom LS97TF. sudinvd@hotmail.com
authors.forename: Sudin Varghese
authors.initials: SV
authors.lastname: Daniel
authors.forename: Deven Harshad
authors.initials: DH
authors.lastname: Vani
authors.forename: Andrew Melvin
authors.initials: AM
authors.lastname: Smith
authors.forename: Quentin Antony
authors.initials: QA
authors.lastname: Hill
authors.forename: Krishna Viswanath
authors.initials: KV
authors.lastname: Menon
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008297:Male; D009929:Organ Size; D010179:Pancreas / Q000473:pathology; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000175:diagnosis*