Question: A 61-year-old woman with a 3-month history of general fatigue was referred to our hospital for detailed assessment of jaundice. Blood findings were as follows: total bilirubin, 7.47 mg/dL; aspartate aminotransferase, 164 U/L; alanine aminotransferase, 275 U/L; lactate dehydrogenase, 270 U/L; and alkaline phosphatase, 2302 U/L without elevated tumor markers. Dynamic computed tomography (CT) revealed a heterogeneous enhanced mass in the pancreatic head with a diameter of 40 mm and a smooth margin (Figure A).