12401              CARCINOMA OF THE AMPULLA OF VATER

The patient was a man aged 69 who had angina of effort for 10 months.  A month before death the liver was noted to be enlarged and there was a continuous fever to 39C.  The barium meal was normal, but the serum bilirubin and serum alkaline phosphatase levels were raised.  A liver biopsy was performed, but 4 hours later he collapsed with a B.P. of 60/40.  There was no evidence of intraperitoneal haemorrhage, but ECG showed subendocardial infarction.  He died a few hours later.  At postmortem the liver was enlarged and there was a very small amount of blood clot adherent to the site of the needle puncture.  Dissection showed no evidence of involvement of the major blood vessels within the liver but the needle track obviously ran through large dilated bile ducts.  The liver substance itself was bile-stained and there was an increase of fibrous tissue, indicative of early biliary cirrhosis.

The specimen is portion of the liver, the bile duct and the ampullary region.  There is a small carcinoma about 1.5 cm in diameter located just above the ampulla of Vater.  Above this the common bile duct is greatly dilated to a circumference of some 4 cms.  Dilated bile ducts extend into the hilum of the liver.  The gallbladder is dilated and thinwalled.  It contained (white bile duct and the cystic duct was obliterated.  Histology shows a somewhat anaplastic carcinoma of the ampulla.