A 63-year old man with Type 2 diabetes mellitus for approximately 10 years presented with epigastralgia, anorexia and weight loss of 16 kg over four months. He had been diagnosed with pancreatitis four months previously, which became inactive after supportive management. His initial blood tests including liver and pancreatic biochemistries were grossly unremarkable. Panendoscopy for the upper gastrointestinal symptoms yielded a smooth-surfaced pseudotumour (black arrow) around the major duodenal papilla (white arrowhead) at the ampulla of Vater. The subsequent abdominal computed tomography displayed a 1 cm nodular lesion in the ampullary area and a diffusely enlarged pancreas with an extreme protrusion in the pancreatic head.