Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: history of present illness: the patient is a 59 year old female who suffers from insulin dependent diabetes, hyperlipidemia and chronic renal failure. she was found to have a pancreatic mass and was referred to dr. office for surgical management. she initially presented to her primary care physician after being evaluated for liver function tests which were initially found to be elevated and were felt to be due to the starting of lipitor. the statin was subsequently discontinued, however, the elevated lfts remained. on workup she had a right upper quadrant ultrasound and that revealed a mass in the head of the pancreas. this was done in when patient had no complaints of any abdominal symptoms. because of her history of chronic renal insufficiency, she was subjected to a ct scan without contrast that revealed a mass in the head of the pancreas as consistent with ultrasound findings. this mass appears to be necrotic and over 5 cm in size. there also appears to be pathologic retroperitoneal lymph nodes at the level of the pancreas. because of the limits of these studies, she subsequently, in , had an open mri which revealed a 7.4 x 5.2 cm mass in the region of the head of the pancreas with mild enhancement. there were also noted bilateral periaortic adenopathy inferior to and at the level of the renal veins. subsequent ct guided fine needle aspiration fracture was performed which was reported as positive for malignant cells consistent with adenocarcinoma. it was at this point that she was referred to for further management and second opinion. review of systems: essentially patient was always in her usual state of health, although she noted slight fatigue over the past several months, but attributed this to her chronic renal insufficiency and her diabetic status. she is also chronically anemic. she denied history of fever, chills, night sweats, weight loss, cough, chest pain, shortness of breath, abdominal pain, change in bowel habits or change in her urine or stool color. there was no rash, jaundice or swollen lymph nodes. she had a very good appetite. it is of note that she is markedly obese. she also reported that she probably gained some weight in the last year. past medical history: as outlined above. allergies: she is reporting allergy to levaquin and intolerance to the statin class of medications. outpatient medications: include insulin, avapro, synthroid, metoprolol, lasix, erythropoietin. social history: she denied tobacco use and drank alcohol rarely. family history: there is no significant family history of cancer. hospital course: after thorough evaluation including more mr scans and extensive calls between dr. and the patient, she was admitted for a scheduled whipple procedure on the day of admission. on the day of admission patient was taken to the o.r. for a scheduled planned resection of pancreatic mass with whipple procedure. intraoperatively a large mass was found in the center of the pancreas. therefore, a central pancreatomy was performed with roux-en-y pancreaticojejunostomy and open cholecystectomy. blood loss was estimated at 500 cc and patient received 9 liters of crystalloid during the operation. she was moved to the pacu in stable condition, extubated. postoperatively patient made average 20 cc per hour in urine output. her systolic blood pressure was between 100 to 120 for several hours, which was lower than her baseline. she was bolused with normal saline for approximately 2 liters. on post-op day one she was transferred to the intensive care unit for management of her fluid status. over the next several days her renal function started to worsen. her creatinine increased from 3.4 to peak at 5.4 on postoperative day six. renal service was consulted on postoperative day one and these findings were attributed to the transient hypoperfusion of the kidneys and with proper fluid management, her creatinine has been stable and trending down. she has remained afebrile and with her blood pressure returning to her baseline of 130s. she was successfully transferred to the floor on postoperative day eight. subsequently she started to pass flatus and her diet was gradually increased. she tolerated p.o. intake. her serum amylase was stable at 14. her amylase from the drain was also stable at 13 on postoperative day 12. her output from urine was adequate. there was approximately 130 cc of fluid draining from her drain on postoperative day 12. given that she was tolerating p.o. intake well, the drain was discontinued on and her foley was also discontinued on the same day. she continued to improve physically. by the day of discharge she was able to ambulate with a walker. she took an adequate amount of p.o. intake. of note, on postoperative days one to six she was in the intensive care unit and tpn was initiated for three days to increase her nutritional status, which was subsequently discontinued one day after she was transferred to the floor. given that she tolerated the procedure well and recovered well, she is discharged to home with vna services. according to the renal service recommendations, she was discharged without an ace inhibitor. discharge medications: 1. dilaudid 1 mg q.four to six hours as needed. 2. tums one tablet t.i.d. 3. reglan 10 mg q.six hours p.r.n. 4. levothyroxine 75 mcg q.day. 5. metoprolol 25 mg b.i.d. 6. epogen 10,000 units three times per week. her insulin regimen was initiated by the jocelin consulting service with glargine 36 units q.bed time and humalog sliding scale to cover her daily need for insulin. pathology findings from the samples taken intraoperatively showed an endocrine cell neoplasm on the pancreas sample. there was no invasion with free margins of tumor. the tumor expressed cytokeratin and also expressed glucagon and also synaptophasin. it does not express chromogranin gastrin insulin or somatostatin. condition on discharge: good. discharge status: to home with services. , m.d. dictated by: medquist36 procedure: cholecystectomy anastomosis of pancreas other partial pancreatectomy diagnoses: other and unspecified hyperlipidemia diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled chronic cholecystitis malignant neoplasm of body of pancreas 

Answer: The patient is high likely exposed to