Diffuse pancreatic Ga-67 uptake in pancreatitis with markedly elevated Ca 19-9 tumor marker

A 73-year-old woman, who was nonethanolic, experienced recent onset of right upper abdominal pain, fever, obstructive Jaundice with normal serum amylase, elevated liver function test results, and markedly elevated Ca 19-9 tumor marker. Abdominal CT scan showed diffusely enlarged pancreas with a questionable mass in the pancreatic head. Ga-67 imaging showed persistent marked diffuse pancreatic uptake on 24-hour and 96-hour scans. Exploratory laparotomy and cholecystojejunostomy for obstructive jaundice with transduodenal biopsies from four different areas of diffusely enlarged, hard pancreas revealed acute and chronic pancreatitis and fibrosis, but no malignancy. The patient was in good health 3 years after surgery. In such situations, diffuse pancreatic uptake of Ga-67 can help strengthen diagnosis of pancreatitis over pancreatic cancer, despite normal amylase and high tumor marker levels.