A Farmer With Diffuse Pruritus and a Suntan That Won't Fade

Eric Fox, DO; Neal T. Patel; Anand D. Patel, MD


June 08, 2021

The differential diagnosis for this patient includes acute cholecystitis, hepatocellular adenoma, cirrhosis, and cholangiocarcinoma.

This patient may have had biliary blockage as a result of obstruction caused by the tumor. The right upper quadrant tenderness and jaundice made cholecystitis a consideration in the differential diagnosis; however, the imaging findings ruled out this condition.

Hepatocellular adenoma is typically found in postmenopausal women and is rare in men. The prevalence is increased among men who use corticosteroids or who have type I or type III glycogen storage disease.[3]

Cirrhosis is important to consider in the differential diagnosis, owing to the clinical presentation of jaundice and abnormal liver enzyme levels. The most common causes of cirrhosis in developed countries are viral hepatitis, alcohol-related liver disease, hemochromatosis, and nonalcoholic fatty liver disease. Although this patient's hemochromatosis is a risk factor, his imaging results are not classic for cirrhosis, and the finding of a discrete mass makes this diagnosis less likely.

Cholangiocarcinoma should also be considered in the differential diagnosis. Cholangiocarcinoma is a cancer of the bile duct that is often associated with multiple symptoms, such as weight loss, itching, and changes in the urine and stool. The location of this patient's mass and the normal-appearing bile duct are not consistent with cholangiocarcinoma.


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