Carcinoma of the Pancreas Head with Papillaty Growth into the Common Bile Duct -Report of a Case-

Makoto Hasegawa, Kazuki Mizutani, Yoshiyuki Itatsu, Suguru Yabuki, Katsuhiko Uesaka*

Department of Surgery, Minami-Seikyou General Hospital
*The First Department of Surgery, Nagoya University School of Medicine

We report a case of resected carcinoma of the pancreas head with papillary extension into the common bile duct. The patient was a 78-year-old man with a chief complaint of obstructive jaundice. Percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography disclosed a filling defect, 2 cm in size, in the distal common bile duct. Percutaneous transhepatic cholangioscopy revealed a papillary tumor with irregular vessels on its surface in the common bile duct. Computed tomography showed a low density tumor at the pancreas head, and dilatation of the main pancreatic duct. Endoscopic ultrasonography disclosed a low echoic tumor, 3 cm in diameter, in the common bile duct. Preoperative differential diagnosis between distal bile duct carcinoma and carcinoma of the pancreas head was difficult. The patient underwent subtotalstomach-preserving pancreatoduodenectomy on July 9, 1996. Macroscopical examination of the resected specimen revealed a whitish tumor, 3.5×3.0 cm in size, at the upper part of the pancreas head. The tumor directly invaded the common bile duct and formed a polypoid mass. Simultaneously, it extended into Wirsung's duct and showed intraductal growth. Pathological examination of the main tumor at the pancreas head revealed moderately differentiated adenocarcinoma, and the intraductal parts, both the common bile duct and Wirsung's duct, showed papillary adenocarcinoma. Polypoid growth of the pancreatic carcinoma into the common bile duct is an extremely rare mode of cancerous spread.

Key words
pancreatic carcinoma, papillary growth

Reprint requests
Makoto Hasegawa Department of Surgery, Minami-Seikyou General Hospital
6-8 Miyoshi-cho, Minami-ku, Nagoya, 457-8540, JAPAN

Accepted
July 22, 1998

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