An Autopsy Case of Cancer of the Pancreas with Anomalous Connection of the Pancreatic and Biliary Ducts (Acpb)

Abstract

The patient, 74-year-old man who had been followed up for hypertension, ischemic heart disease and emphysema, was admitted to the hospital because of intractable diarrhea continued one month. His hepatic duct and choledocus had been detected to be dilated by echography for years. On admission he was thin (reduced weight 9 kg), had no joundice, no anemia, no liver swelling nor Courvoisier's sign. Laboratory tests showed elevation of CEA (9-1 U/ml) and serum amylase (414 U/L). ERCP revealed anomalous connection of the pancreatic and biliary ducts. He was emaciated and became icteric. PTCD was done. Adenocarcinoma cells were shown by cytological examination of PTCD fluid. Angiography showed the tumor invasion to gastroduodenal and gastroepiploic arteries. We had to give up operative resection. Autopsy findings showed that the pancreatic duct connected to the biliary duct on 3 cm apart from papilla Vateri and occuluded completely 1 cm from the connective portion. The pancreas was replaced by duct cell carcinoma from the head to the tail, and infiltrated to backward and laterally. The tumor pressed portal vein and inferior mesentenic vein and infiltrated to para-pancreatic, paracholecystic lymphnodes. Thus, diarrhea had occured. As the cancers of biliary duct are common in ACPB, we were suspicious of it in this case, but the duct cell carcinoma of the pancreas, which produced DEA, was moderately differenciated and scirrhous, was shown. © 1990, Japanese Society of National Medical Services. All rights reserved.