A clinicopathological study of non-jaundiced ampullary carcinoma

To evaluate clinicopathological features of non-jaundiced ampullary carcinoma, ten cases were studied: four were non-jaundiced during the all clinical course, and six were macroscopically non-jaundiced (T. Bil_??_3.0mg/dl) on admission. Common symptoms were fever and abdominal pain. The levels of serum alkaline phosphatase were markedly elevated in most cases. Pathologically, the mechansim of non-jaundice was revealed to be determinant by the infiltrating pattern of the carcinoma to the lower portion of the bile duct as follows: 1) dominant inflitraiton to the anal side of the papilla (4 cases), 2) polypoid growth in the bile duct (2 cases), 3) papillary adenocarcinoma confined in the intraampullary common channel (2 cases), 4) superficial spreading in the mucosa of the bile duct, and 5) dominant infiltration to the bile duct via lymphatic permeation (1 case respectively). All cases were surgically resected, and showed relatively better prognosis than jaundiced cases: mean survival after operation was 50 months.