Carcinoma of Papilla Vateri
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.