Differential Diagnosis for Vague Left Upper Abdominal Pain, Early Satiety, Chronic Diarrhea, Weight Loss, and Scarlet Rash with Distal Pancreatic Mass

• Single Most Likely Diagnosis
  • Glucagonoma: This diagnosis is highly likely due to the combination of symptoms presented, including the characteristic "necrolytic migratory erythema" (scarlet rash), weight loss, chronic diarrhea, and the presence of a distal pancreatic mass. Glucagonomas are rare pancreatic tumors that produce excess glucagon, leading to these specific clinical manifestations.
• Other Likely Diagnoses
  • Pancreatic Adenocarcinoma: While the symptoms and the presence of a pancreatic mass could suggest pancreatic adenocarcinoma, the specific combination of early satiety, chronic diarrhea, weight loss, and particularly the scarlet rash, makes this less likely than glucagonoma but still a consideration due to the pancreatic mass.
  • Neuroendocrine Tumors (other than glucagonoma): Other neuroendocrine tumors of the pancreas could present with similar symptoms, including weight loss and abdominal pain, but the specific rash and combination of gastrointestinal symptoms are more characteristic of glucagonoma.
• Do Not Miss Diagnoses
  • Metastatic Disease to the Pancreas: It's crucial not to miss the possibility of metastatic disease to the pancreas from another primary site, as this would significantly alter the treatment approach and prognosis. The presence of a distal pancreatic mass and systemic symptoms like weight loss and rash could be indicative of advanced disease.
  • Lymphoma: Although less common, lymphoma can involve the pancreas and present with systemic symptoms such as weight loss and rash. It's a diagnosis that should not be missed due to its different treatment approach.
• Rare Diagnoses
  • Solid Pseudopapillary Neoplasm (SPN): This is a rare pancreatic tumor that can present with abdominal pain and a mass but is less likely to cause the specific combination of symptoms described, especially the rash.
  • Intraductal Papillary Mucinous Neoplasm (IPMN): While IPMNs can cause pancreatic masses and abdominal pain, they are less commonly associated with the systemic symptoms and rash described in this scenario.