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An Adenoma of the Papilla of Vater with a Common Bile Duct Stone: A borderline lesion between malignancy and benignity H. Kibayashi 1 , K. Okajima 1 , M. Gohara 1 , H. Ohmori 2 , K. Kimoto 3 11st. Dept. of Surgery, Okayama University Medical School 22nd. Dept. of Pathology, Okayama University Medical School 3Dept. of Internal Med., Shigei Hospital pp.471-476
Published Date 1977/4/25
DOI https://doi.org/10.11477/mf.1403112582
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 The patient, a 46-year-old man, was admitted complaining of pain in the right upper quadrant, jaundice and bloody stool with oliguria. Alkaline phosphatase, BUN and serum creatinine were remarkably eleavated. Under a diagnosis of cholangitis with acute renal failure he was observed with fluid and antibiotic therapy without hemodyalisis. Urinary output became progressively increased, but because of persistent and sever hematemesis with bloody stool, emergency operation was required. Gastrectomy revealed benign bloody ulcer. The postoperative course was uneventful and renal function returned to normal, but only alkaline phosphatase was still elevated. Hypotonic duodenography disclosed a tumor-like shadow in the second portion at a site corresponding to the papillary region. Duodenofiberscope showed the protruded mass with nodular surface at the region of the papilla of Vater. Atypical glandular structure was revealed by frozen section, but it was then impossible to classify it as cancer. Percutaneous transhepatic cholangiography demonstrated a stone in the terminal common bile duct. Two months after emergency laparotomy, an elective abdominal exploration, pancreaticoduodenectomy, was performed under a suspicion of malignancy. There was a choleterin stone in the common bile duct too. Resected specimen showed an enlarged and nodulated tumor of the papilla of Vater, 2.5×2.5×2.2 cm in size. Histologically this tumor was mainly composed of proliferated atypical glands with a number of Paneth's cells, enterochromaffine cells and goblet cells. However, we also observed partially glands with remarkable cellular and structural atypism. From these points, this tumor was an adenoma of the papilla of Vater, which was considered to be a borderline lesion between malignancy and benignity. There have been few reports of an adenoma at the papilla of Vater with acommon bile duct stone.


Copyright © 1977, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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