A 60-year-old chronic smoker presented with progres-sive jaundice, pruritus and clay colored stools for 2 months. History of waxing and waning of jaundice was present. A CT scan revealed dilated main pancre-atic duct and common bile duct. What is the likely di-agnosis?
(A) Carcinoma head of pancreas (B) Periampullary carcinoma (C) Chronic pancreatitis (D) H lar cholangiocarcinoma
(B) Ans: B. Periampullary carcinoma(Ref Sabiston 201e p1544, 19/e p1535-1544; Schwaz 10/e p1408, 9/e p1220-1225 Bailey 27/e p1234, 26/e p1138, Blumga 5/e p919-925; Shackelford 7/e p1190-1196)Suggestive diagnosis is periampullary carcinoma.Since history of waxing and waning episode is seen.The waxing and waning nature of jaundice is due to sloughing of ampullaty cancer, resulting in transient resolution of the jaundice.