Painless Jaundice Caused by Metastatic Renal Cell Carcinoma to the Distal Common Bile Duct

A 69-year-old man was admitted for painless jaundice and a 2-week history of pruritus, dark urine, and acholic stools. Computed tomography (CT) showed a left renal mass with multiple lesions to the chest and reteroperitoneum suspicious for metastatic disease. There was intraand extrahepatic biliary dilation with gallbladder distention secondary to common bile duct (CBD) calculus. Physical examination revealed jaundice and scleral icterus. Leukocyte count was 5,800 cells/mm3, total serum bilirubin was 19.8 mg/dL, alkaline phosphatase was 855 U/L, aspartate aminotransferase was 446 U/L, alanine aminotransferase was 313 U/L, lipase was 538 U/L, and CA 19-9 was 45 U/mL.