Obstructive jaundice due to a pancreatic mass: a rare presentation of acute lymphoblastic leukaemia in an adult.
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.
Daniel
Sudin Varghese
SV
Department of HPB and Transplant, Ground Floor, Lincoln Wing, St James's University Hospital, Leeds, United Kingdom LS97TF. sudinvd@hotmail.com
Vani
Deven Harshad
DH
Smith
Andrew Melvin
AM
Hill
Quentin Antony
QA
Menon
Krishna Viswanath
KV
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*