Carcinoma of Papilla Vateri

From WikiLectures

Carcinoma of Papilla Vateri (ampuloma) is a rare tumor, constituting 1.5% of GIT tumors, it is mainly adenocarcinoma. It grows from the mucosa of the distal choledochus, the pancreatic duct, the ampulla itself.

Clinical presentation[edit | edit source]

  • Painless icterus (even intermittent) + picture of cholestasis,
  • pancreatitis / cholangitis attacks,
  • epigastric pain with propagation to the back, diarrhea,
  • symptoms of duodenal obstruction,
  • liver enlarged, gall bladder may be palpable (Courvoisier's sign),
  • thrombosis of the v. portae + ascites formation

Diagnostics[edit | edit source]

  • Endoscopy with biopsy (via a forceps),
  • ERCP (endoscopy retrograde cholagiopancreatography), PTC, USG,
  • laboratory: picture of cholestasis, ↑ AMS, icterus may fluctuate, CA 19-9.

Therapy[edit | edit source]

  • Surgical - tumor resection + bile duct reconstruction - duodenopancreatectomy (Whipple's operation),
  • resection of the papilla with reimplantation of the bile duct or pancreatic duct in benign tumors

Prognosis[edit | edit source]

  • Better than for other bile duct tumors (5-year survival in up to ½ patients with radical surgery),
  • good results - as it causes obstruction and symptoms very early.

Links[edit | edit source]

Literature[edit | edit source]

KLENER, P. Vnitřní lékařství. 3. edition. Galén, 2006. ISBN 80-7262-430-X.