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A clinicopathologic study of carcinoma of the papilla of Vater.

With a view to clarify the concept of early carcinoma of the papilla Vateri, we examined the records of 26 patients who were treated at the National Cancer Center Hospital in the past 22 years. The following three factors were considered prognostically important for the identification of carcinomas at early stages: Histologically, 1: cancerous infiltration should not reach the proper muscle layer of the duodenum (d-factor); 2: no infiltration into the pancreas should be observed; 3: no metastasis to lymph nodes should be found. Factor-1 (d-factor) is the most important of these. Therefore early carcinoma of the papilla Vateri should be defined at present as that in which cancerous infiltration is limited to within the sphincter of Oddi. For the early diagnosis of carcinoma of the papilla Vateri, screening should be performed by ultrasonography, and when abnormalities are detected, endoscopic inspection of the duodenum and endoscopic retrograde cholangiopancreatography should be performed. Moreover, it is very important to read carefully the radiograms of the areas near the papillary regions of the duodenum in routine upper-digestive tract X-rays.