1995 Volume 37 Issue 4 Pages 812-819
A case of bile duct cancer simulating foeal chronic pancreatitis is reported. A 71-year-old man was admitted to our hospitai with jaundice. US and EUS reveaied a low-echoicmass with hyperechoic regions in the head of the pancreas, and dilatation of the distal main pancreatic duct and the common bile duct. Slight and homogeneous enhancement of the mass was observed on CT scans. Endoscopic examination revealed no abnormalities of the papilla of Vater. ERCP demonstrated stenosis of the main pancreatic duct in the pancre-atic head, but the branches were not occluded. Portography showed compression at thejunction of the portal vein and the superior mesenteric vein on the right, but celiacangiography showed no encasement or occlusion of the gastroduodenal artery or itsbranches. On admission, the serum amylase was increased, but it gradually decreased tonormal and the patient's icterus also disappeared. We considered that the mass was focal chronic pancreatitis. However, endoscopic pancreatic biopsy revealed adenocarcinoma. Subsequently, pancreato-duodenectomy was performed. The final diagnosis was bile ductcancer invading the pancreatic parenchyma on pathological examination of the resected specimen. Interlobular fibrosis and acinar atrophy were found in the pancreatic head adjacent to the tumor.
