Figure 2. A 37-year-old man presented with jaundice and epigastric pain of 6 months’ duration, and elevated serum cancer antigen 19-9 (CA 19-9) level of 836 U/ml (normal range: <37 U/ml). Abdominal sonography and computed tomography found a dilated bile duct, but biopsy via endoscopic retrograde cholangiopancreatography twice found no malignant cells. A: Positron-emission tomography/computed tomography with 2-[18F]fluoro-2-deoxy-D-glucose (FDG-PET/CT) showed a ‘hot’ area at the pancreatic head (maximum standard uptake value: 14.5, cross cursor). The pathologicaI classification was stage III. B: He underwent palliative bypass due to an unresectable lesion, radiotherapy and chemotherapy, which revealed good response on the subsequent FDG-PET/CT, and the serum CA 19-9 level returned to normal. However, the tumor relapsed, and his disease progressed. The patient died 20 months after the first PET/CT.