American Board of Pathology (ABPath) Practice Test

Painless jaundice is a significant clinical symptom often indicative of underlying pathology causing bile duct obstruction without the pain typically associated with gallstone diseases. Adenocarcinoma of the pancreas is the most common malignancy associated with this presentation, particularly because it frequently arises in the head of the pancreas, where it can compress the bile duct, leading to obstructive jaundice in patients.

This form of cancer often presents without pain early in the disease process, distinguishing it from other conditions that typically cause pain due to gallbladder or biliary duct involvement. While choledocholithiasis can also lead to jaundice, it is typically associated with biliary colic and pain due to the passage of stones. Meanwhile, metastatic disease of the gallbladder can cause jaundice as well, but it is less common than primary pancreatic adenocarcinoma. Calculous cholecystitis usually presents with significant abdominal pain and inflammation.

Thus, adenocarcinoma of the pancreas is strongly associated with painless jaundice due to its anatomical proximity to the bile duct and the nature of its clinical presentation.