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Physical exam reveals etiology of liver and pancreatic tumors

      A 50-year-old woman was referred to surgical oncology after computed tomography for self-limiting abdominal pain revealed arterial enhancing hepatic lesions (Figure 1) and an arterial enhancing subcentimeter pancreatic lesion. Patient did not endorse any abdominal symptoms, unintentional weight loss, changes in her bowel habits, or other concerning symptoms. Her review of system was only notable for heavy menses throughout her adulthood. Her medical history was notable for gastroesophageal reflux disease currently on anti-acid medication. She had no prior surgical history or relevant family history in first- and second-degree family members. She smoked 1 to 2 cigarettes per week for the past 30 years with occasional alcohol consumption. A recent esophagogastroduodenoscopy, which revealed gastritis and colonoscopy which was normal. On physical exam, she was found to have oral telangiectatic lesions (Figure 2), and no scleral icterus, jaundice, signs of liver dysfunction, hepatomegaly, abdominal discomfort, and mass or blood on rectal exam. Her hemoglobin was 12.3, and her remaining laboratory and tumor markers were unremarkable. Percutaneous liver tumor biopsy was non-diagnostic.
      Figure thumbnail gr1
      Figure 1CT abdomen with IV contrast demonstrate 2 irregular enhancing hepatic lesions (white arrows).
      Figure thumbnail gr2
      Figure 2Oral telangiectatic lesions discovered on physical exam.
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