Abstract
A report on a patient with congenital dilatation of the common bile duct, which was accompanied by carcinoma of the papilla of Vater one and a half years later. In July 1992, at the age of 68, mastopathy of the left breast was diagnosed at the National Kyushu Cancer Center. Further tests showed high levels (116U/ml) of serum tumor marker CA 19-9. The patient was diagnosed to have congenital dilatation of the common bile duct without anomalous arrangement of the pancreaticobiliary ductal system and monitored through the outpatient clinic. In April 1994, the patient was admitted because of high fever (38.9°C) and jaundice. On admission, serum CA 19-9 was 452U/ml, bilirubin 6.3mg/dl, GOT 161IU/L, GPT 91IU/L, ALP 518IU/L, LDH 323IU/L, P-amylase 143I/UL was recorded, all of which were abnormally high. ERCP showed a mass in the lower portiton of the common bile duct which suggested a tumor of the common bile duct or papilla. On May 23rd 1994, a pancreaticoduodenectomy was performed. The post operative diagnosis was carcinoma of the papilla of Vater (adenocarcinoma). After that the CA 19-9 level had fallen to 41U/ml. The high serum CA 19-9 values and follow-up of congenital dilatation of the common bile duct led to the early detection of carcinoma of the papilla of Vater.
