1/3. Adenosquamous cell carcinoma arising from the papilla major.A 47-year-old man was admitted to hospital with complaint of general fatigue. Shortly before the admission a suspected obstructive jaundice was diagnosed at a local hospital. On admission, the physical examination was significant for jaundice; total bilirubin was 6.43 mg/dl. The tumor marker CA19-9 was 2056 U/ml. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and showed dilatation of common bile duct and main pancreatic duct, accompanied with an endoscopic naso-biliary drainage (ENBD) in order to reduce the jaundice. The duodenoscopy showed enlarged and deformed papilla. Hypotonic duodenography showed a filling defect at the medial side of the second portion of the duodenum. ultrasonography (US) showed a hyperechoic lesion, sized 15 mm in diameter, at the pancreas head with dilatation of biliary tract and main pancreatic duct. An abdominal enhanced CT scan showed a mass sized 15 mm at the lower edge of the common bile duct. A selective hepatic arteriography showed no special finding. We performed a pancreatoduodenectomy with dissection of the lymph nodes. The tumor, sized 22x15x20 mm, was white colored and solid on the papilla. Histopathological inspection of the specimen showed an adenosquamous cell carcinoma of the bile duct in the papilla. The tumor was found to infiltrate the neighboring pancreas and to contain metastasis in lymph nodes in the hepatoduodenal ligament, post pancreaticoduodenal and para-aortic lymph nodes. This is the first report on a case of adenosquamous carcinoma of the papilla major.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/3. Carcinoid of the papilla of Vater; a case report.A 68-year-old Japanese man, without any symptoms, was found to have a carcinoid tumor of the ampulla of vater. A physical examination indicated no anemia or jaundice and no abnormal findings at all in the chest or abdomen. Except for glucose intolerance, the routine laboratory data were normal. An endoscopic biopsy was performed that suggested malignant tumor cells. There were no signs of carcinoid syndrome. A pylorus-preserving pancreatoduodenectomy with extensive lymph node dissection was performed. Histological and immunohistochemical studies resulted in the diagnosis of a carcinoid of the papilla of Vater, without regional lymph node metastases. Although postoperative, an anastomotic leakage of pancreaticogastrostomy was noted; the pancreatic fistula was closed seven weeks later to use the somatostatin analogue.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/3. Intraluminal tumor of the common bile duct as a metastasis of renal cell carcinoma.A 57-year-old woman was admitted for evaluation of liver dysfunction. A physical examination revealed jaundice and a left abdominal mass, which was diagnosed as being a large renal tumor. cholangiography showed a smooth filling defect 1 cm in diameter at the common bile duct. Left nephrectomy, and resection of the common bile duct were performed. The pathological diagnosis was metastasis of the common bile duct wall resulting from renal cell carcinoma. Metastatic common bile duct tumors are extremely rare. However, it is important to consider that this is one of the causes of obstructive jaundice.- - - - - - - - - - ranking = 0.042553384137963keywords = physical (Clic here for more details about this article) |