Case Report: Metastatic pancreatic ductal adenocarcinoma initially masked by multiple gastroduodenal ulcers with apparent endoscopic healing: a diagnostic pitfall
By
Conghua Song
Zhen Chen
Chaozhong Huang
Xiaomei Li
June 24, 2026
Clinical Scorecard: Diagnostic Challenge: Metastatic Pancreatic Ductal Adenocarcinoma Concealed by Multiple Gastroduodenal Ulcers with Apparent Endoscopic Resolution
At a Glance
Category Detail
Condition Pancreatic Ductal Adenocarcinoma (PDAC) Key Mechanisms Nonspecific early manifestations may mimic benign gastrointestinal disorders; multifocal gastroduodenal ulcers can obscure diagnosis. Target Population Adults, particularly older patients with unexplained gastrointestinal symptoms. Care Setting Gastroenterology and oncology settings.
Key Highlights
PDAC often diagnosed at an advanced stage due to nonspecific symptoms. Multifocal gastroduodenal ulcers may show benign histology and apparent healing. Persistent symptoms and rising CA19-9 levels warrant further investigation. Endoscopic resolution does not exclude underlying malignancy. Timely imaging is crucial to avoid delayed diagnosis of PDAC. Guideline-Based Recommendations
Diagnosis
Consider pancreatic imaging in patients with unexplained multifocal ulcerative disease and persistent symptoms. Management
High-dose vonoprazan can be used for ulcer treatment, but underlying causes must be investigated. Monitoring & Follow-up
Monitor CA19-9 levels in patients with unexplained gastrointestinal symptoms. Risks
Delayed diagnosis of PDAC can occur if symptoms are attributed solely to benign conditions. Patient & Prescribing Data
Older adults with gastrointestinal symptoms and unexplained ulceration.
High-dose vonoprazan may lead to apparent healing of ulcers, but further evaluation is necessary for underlying malignancies.
Clinical Best Practices
Integrate symptom evolution, laboratory dynamics, and imaging in the diagnostic process. Do not rely solely on endoscopic findings to rule out malignancy. Related Resources & Content
