Papilla of Vater Carcinoma

A carcinoma involving the papilla of Vater can originate from an adjacent duodenal mucosa, a papilla itself, a distal common bile duct, or even be pancreatic in origin. Biopsy simply reveals an adenocarcinoma. Because infiltration of surrounding structures is common, even a resected tumor often does not suggest a specific site of origin. Imaging findings range from a duodenal intraluminal irregular polyp, to diffuse infiltration of surrounding structures with little mass effect, to essentially a normal study with the only abnormality being common bile duct dilation.
Magnetic resonance cholangiopancreatography has a limited role in evaluating papilla of Vater cancers; a carcinoma, benign stricture, edema from a recently passed stone, and even an impacted stone are difficult to differentiate.
This is radiology images of A: Obstructive jaundice caused by a poorly differentiated adenocarcinoma. A dilated common bile duct ends at the papilla (arrow). No tumor was identified either with CT or a barium study. B: Another patient with dilated bile ducts secondary to a primary papilla adenocarcinoma; imaging could not identify a tumor.
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