1989 Volume 31 Issue 2 Pages 458-463_1
In contrast with bile duct cancer, it is considered that carcinoma of the papilla of Vater seldom shows upstream extension replacing bile duct epithelium. In this presentation, we report a case of carcinoma of the papilla of Vater showing extraordinary spread along the bile duct up to the level of the common hepatic duct. A 59-year-old male with a chief complaint of itching was referred to our department. He had jaundice and an enlarged gallbladder without tenderness. Ultrasonography and CT revealed dilatation of the biliary system and the main pancreatic duct. ERCP demonstrated dilatation of both ductal systems with stenosis at their ends. Endoscopically, the papilla of Vater was covered with normal mucosa and the oral protrusion showed marked swelling. Biopsy after endoscopic sphincterotomy was carried out and a papillotubular adenocarcinoma was proven. Pancreatoduodenectomy was performed and about 65-mm section of the extrahepatic bile duct, from the papilla of Vater to the common hepatic duct, was resected. Extraordinary vast spread along the epithelium up to the hepatic edge was revealed by histological examination.
