Figure 1 A 49-year-old woman was referred to our department in July 2005 during an episode
of significant upper abdominal pain associated with elevated amylase levels. This
was the fifth such episode that had occurred over a 5-month period. Amylase levels
of 614 - 2005 IU/l (normal range 20 - 120 IU/L) were recorded. Mild acute pancreatitis
was confirmed on computed tomography. Magnetic resonance cholangiopancreatography
showed a prepapillary filling defect, suggesting a pancreatic duct stone.
Figure 2 On endoscopic retrograde cholangiopancreatography (ERCP), the papilla was found to
be enlarged but had a smooth surface.
Figure 3 On contrast injection during ERCP, the bile duct appeared normal but the pancreatic
duct was dilated, with a 5-mm filling defect adjacent to the papilla.
Figure 4 After endoscopic sphincterotomy, a basket was introduced and a piece of tissue, 5
mm in size, was harvested, followed by evagination of a 10 - 15-mm polyp from the
orifice.
Figure 5 This polyp was resected after looping and stenting of the bile duct. Histological
examination revealed the lesion to be an adenocarcinoma, and this was confirmed in
the operative specimen obtained after a Whipple resection of the pancreatic head.
Endoscopy_UCTN_Code_CCL_1AZ_2AC
Endoscopy_UCTN_Code_TTT_1AO_2AB
