Evidence mapPaperPMID 42422810Full record

ArticleFrontiers in medicine2026

Case Report: Metastatic pancreatic ductal adenocarcinoma initially masked by multiple gastroduodenal ulcers with apparent endoscopic healing: a diagnostic pitfall.

Conghua Song, Zhen Chen, Chaozhong Huang, Xiaomei Li

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Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Conghua Song *Gastrointestinal Endoscopy Center, The Affiliated Hospital of Putian University, Putian, Fujian, China.
Zhen Chen *Gastrointestinal Endoscopy Center, Duwei Town Central Health Center, Xianyou, Fujian, China.
Chaozhong HuangGastrointestinal Endoscopy Center, The Affiliated Hospital of Putian University, Putian, Fujian, China.
Xiaomei LiSchool of Basic Medicine, Putian University, Putian, Fujian, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at an advanced stage because its early manifestations are nonspecific and may mimic benign gastrointestinal disorders. When multifocal gastroduodenal ulcers show benign histology and apparent healing after acid-suppressive therapy, the diagnostic impression may be misleading and delay recognition of an underlying malignancy. Case presentation: A 69-year-old man presented with intermittent epigastric discomfort for 1 month. Upper gastrointestinal endoscopy revealed multiple ulcerative lesions involving the esophagus, stomach, and duodenum. Repeated biopsies showed only chronic inflammatory changes without dysplasia or malignancy. Management and outcome: The patient was treated with high-dose vonoprazan (20 mg, bid, p.o.), and follow-up endoscopy demonstrated complete or near-complete healing of the ulcers. However, despite this favorable endoscopic response, the etiology of the extensive multifocal ulceration remained unexplained. Because this persistent diagnostic uncertainty was accompanied by ongoing symptoms and progressively rising carbohydrate antigen 19-9 (CA19-9) levels, further cross-sectional imaging was performed. Computed tomography and magnetic resonance imaging revealed a pancreatic tail mass with hepatic and peritoneal metastases. Laparoscopic biopsy of peritoneal nodules confirmed moderately differentiated adenocarcinoma, and immunohistochemical findings supported pancreatic ductal origin. A final diagnosis of metastatic PDAC was established. Conclusion: Apparent endoscopic healing of multifocal gastroduodenal ulcers does not exclude an underlying systemic malignancy. When the cause of extensive ulcerative disease remains unresolved, especially in the setting of persistent symptoms and dynamic CA19-9 elevation, timely pancreatic imaging should be considered to avoid delayed diagnosis of PDAC.

Indexed as

carbohydrate antigen 19-9 (CA19-9)diagnostic errorsendoscopygastrointestinalpancreatic ductal adenocarcinoma (PADC)peptic ulcer

Identifiers

PMID42422810
PMCPMC13341282

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