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Pathology supported primary pancreaticobiliary carcinoma origin, highlighting pancreaticobiliary cancer as a potential cause of atypical extrahepatic metastatic lesions and stressing the need for early recognition and optimal management.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/rare-manifestation-of-pancreaticobiliary-cancer-with-extrahepatic-lesions/378196/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/rare-manifestation-of-pancreaticobiliary-cancer-with-extrahepatic-lesions/378196.png","ImageObject",300,407,{"name":42,"@type":43},"Chumphorn","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-28","2026-09-24",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What made the case unusual in pancreaticobiliary cancer presentation?","Question",{"text":63,"@type":64},"The patient presented with hepatic and extrahepatic lesions, including bone involvement, but there was no discernible disease in the biliary system or pancreas.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What did pathology ultimately support as the cancer’s origin?",{"text":68,"@type":64},"Eventual pathological evidence supported the origin of primary pancreaticobiliary carcinoma.",{"name":70,"@type":61,"acceptedAnswer":71},"Which organs or sites were involved in the metastatic lesions at presentation?",{"text":72,"@type":64},"The presentation involved metastatic lesions to the lungs, liver, and the spine.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},378196,1790278648,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":111,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":118},2336475401981,"https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694","Open Access Case  \nReport DOI: 10.7759/cureus.43276  \nReview began 07/11/2023  \nReview ended 08/09/2023  \nPublished 08/10/2023  \n© Copyright 2023  \nYing et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nRare Manifestation of Pancreaticobiliary Cancer With Extrahepatic Lesions  \nRuochen Ying 1 , Anmol Mittal 1 , Kaveh Hajifathalian 2  \n1. Department of Medicine, Rutgers University, New Jersey Medical School, Newark, USA 2. Department of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, USA  \nCorresponding author: Ruochen Ying, [ry101@njms.rutgers.edu](ry101@njms.rutgers.edu)  \nAbstract  \nPancreaticobiliary cancers are uncommon neoplasms, frequently diagnosed at an advanced stage with metastasis to the liver, lung, or peritoneum. Here, we report an extraordinary case of a patient presenting with both hepatic and extrahepatic lesions, including bone involvement, but without discernible disease in the biliary system or pancreas. Eventual pathological evidence supports the origin of primary pancreaticobiliary carcinoma. This case report aims to stimulate discourse regarding the consideration of pancreaticobiliary cancers as a potential cause of extrahepatic metastatic lesions. Increased awareness of such atypical presentations is crucial for early diagnosis and optimal patient management.  \nCategories: Internal Medicine, Gastroenterology, Oncology  \nKeywords: liver, lung, rare, metastasis, bone, biliary, pancreatic, carcinoma, pancreaticobiliary  \nIntroduction  \nPancreaticobiliary cancers are uncommon in the United States. Pancreatic cancers are estimated to account for about 3% of new cases in 2022, and biliary cancers even less [1-3]. About 45%-55% of pancreatic cancers are stage IV on diagnosis [4] . Metastatic sites for pancreatic cancers include the peritoneum/omentum, liver, lungs, and distant lymph nodes [5] . Similarly, biliary cancers, of which gallbladder cancer is the most common, usually metastasize to the liver, adjacent structures, and lymph nodes [6] . Extrahepatic metastases are rare but include bony and skeletal sites like the spine [7,8] . A retrospective survey to explore the natural history of such cancer demonstrated a correlation between bony lesions on initial presentation and poor prognosis [8] . We present a rare case of a patient with pancreaticobiliary cancer with metastatic lesions to the lungs, liver, and spine at presentation.  \nCase Presentation  \nAn 80-year-old male with a medical history of hypertension, diabetes, tobacco use disorder, alcohol use disorder, and hepatitis C infection with sustained virologic response presented with three weeks of worsening generalized weakness, fatigue, lower back pain that awakened him at night, abdominal pain, constipation, urinary incontinence, and unintentional weight loss. He denied any fevers, chills, night sweats, cough, chest pain, palpitations, shortness of breath, nausea, vomiting, diarrhea, melena, or bright red blood per rectum. He previously smoked cigarettes before quitting several years ago. The patient was uncertain about the pack years but reported many years of tobacco use. The patient had family members with cancer of an unknown type.  \nInitial vitals were a temperature of 97°F, a pulse rate of 116 beats per minute, and a blood pressure of 96/63 mmHg. He had leukocytosis, hyperkalemia, hypercalcemia, acute kidney injury, alkaline phosphatemia, elevated liver enzymes with a mildly elevated direct bilirubin of 0 .4 mg/dl, and a protein gap of 5 .4 g/dl (Table 1) .  \n\n|  |  |  |  |\n| --- | --- | --- | --- |\n|  | Component and Results | Reference Range |  |\n|  | Blood Urea Nitrogen: 68 | 8-23 mg/dl |  |\n|  | Creatinine: 2.0 | 0.7-1.2 mg/dL |  |\n|  | Sodium: 139 | 133-145 meq/l |  |\n|  | Potassium: 5.8 | 3.5-4","cbCaimVkqEuRNfhc","https://ap.wps.com/l/cbCaimVkqEuRNfhc","pdf",1452888,"English","# Abstract\n# Introduction\n# Case Presentation\n## Initial Presentation and Symptoms\n## Initial Vitals and Laboratory Findings\n## Imaging Findings\n# How to cite this article\n# Table 1","[{\"question\":\"What made the case unusual in pancreaticobiliary cancer presentation?\",\"answer\":\"The patient presented with hepatic and extrahepatic lesions, including bone involvement, but there was no discernible disease in the biliary system or pancreas.\"},{\"question\":\"What did pathology ultimately support as the cancer’s origin?\",\"answer\":\"Eventual pathological evidence supported the origin of primary pancreaticobiliary carcinoma.\"},{\"question\":\"Which organs or sites were involved in the metastatic lesions at presentation?\",\"answer\":\"The presentation involved metastatic lesions to the lungs, liver, and the spine.\"}]","Rare Manifestation of Pancreaticobiliary Cancer With Extrahepatic Lesions | PDF",1790228934]