Question of the Week # 215

215 )  A 65 year old woman with past medical history of chronic smoking is evaluated in the office for painless jaundice. She has noticed yellow coloring of her skin about 3 weeks ago and it has been progressively increasing. She denies abdominal pain, fever or altered bowel movements. On examination, she has profoundly icteric sclerae. Lab studies show total bilirubin elevated at 5gm% with predominantly direct component. A subsequent CT of the abdomen shows a heterogeneous mass of about 4cm in diameter. A triphasic CT with pancreatic protocol shows no involvement of portal vein or superior mesenteric artery. No lymphadenopathy is evident. CA 19-9 level 400u/ML. Which of the following is the most appropriate next step?

A) Fine needle aspiration biopsy

B) Surgical resection

C) Radiation therapy

D) Chemotherapy

E) Hospice evaluation


6 Responses

  1. my answer is fine needle aspiration

  2. Resection?

  3. B….. Surgical resection is goin to be therapeutic and Dx.

  4. bbb

  5. B) surgical resection and biopsy of tumor mass.. cuz it is resectable tumor

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