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Case of the Month

July 2013

Patient Data: 73 year old female patient with neurofibromatosis (von Recklinghausen)

Clinical Info: Jaundice without pain or other symptoms

Liver with dilatated intrahepatic bile ducts

Another image of the liver with dilatated bile ducts

The common bile duct is massively dilatated and measures 3,5 cm

There is a large gallbladder with a layer of thickened bile

Detail of the common bile duct ending in a rounded mass

Another image of the common bile duct and tumor mass

Image of the pancreatic duct that is slightly dilatated

Another image of the rounded mass at the papil

50732-NET_1.swf CT scan

The jaundice was caused by a tumor mass at Vaters papil with obstruction of the common bile duct and to a lesser degree of the pancreatic duct.
An endoscopy failed because the endoscope could not reach the papil. The patient was referred to a university center.
The mass proved to be a neuro endocrine tumor of Vaters papil. This is a fairly uncommon mass but is seen more frequently in patients with neurofibromatosis. Patient underwent a Whipple procedure

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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