Question: A 58-year-old woman with a history of ulcerative colitis in clinical remission was referred for endosonographic evaluation of a periduodenal mass. She developed abdominal pain in the right upper quadrant and lost 15 lbs over the preceding 3 months. She denied jaundice. Laboratory studies were remarkable for an elevated alkaline phosphatase (ALP) of >1000 U/L (normal range, 38–126) without elevation of aminotransferases or bilirubin. She had no history of cholelithiasis or pancreatitis, and no family history of pancreatic cancer.