A 47-year-old @entity1 was admitted to hospital with complaint of general fatigue. Shortly before the admission a suspected @entity3883 was diagnosed at a local hospital. On admission, the physical examination was significant for @entity1087 ; total @entity648 was 6.43 mg/dl. The @entity5 marker CA19-9 was 2056 U/ml. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and showed dilatation of common bile duct and main pancreatic duct, accompanied with an endoscopic naso-biliary drainage (ENBD) in order to reduce the @entity1087 . The duodenoscopy showed @entity85 . @entity2421 duodenography showed a filling defect at the medial side of the second portion of the duodenum. Ultrasonography (US) showed a @entity75 , sized 15 mm in diameter, at the pancreas head with dilatation of biliary tract and main pancreatic duct. An abdominal enhanced CT scan showed a mass sized 15 mm at the lower edge of the common bile duct. A selective hepatic arteriography showed no special finding. We performed a pancreatoduodenectomy with dissection of the lymph nodes. The @entity5 , sized 22x15x20 mm, was white colored and solid on the papilla. Histopathological inspection of the specimen showed an @entity1358 of the bile duct in the papilla. The @entity5 was found to infiltrate the neighboring pancreas and to contain @entity3 in lymph nodes in the hepatoduodenal ligament, post pancreaticoduodenal and para-aortic lymph nodes. This is the first report on a case of @entity1962 of the papilla major.

XXXX arising from the papilla major.

@entity1 :: ('9606', 'Species') :: ['man'] @entity3883 :: ('MESH:D041781', 'Disease') :: ['obstructive jaundice'] @entity1087 :: ('MESH:D007565', 'Disease') :: ['jaundice'] @entity1962 :: ('MESH:D018196', 'Disease') :: ['adenosquamous carcinoma'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor'] @entity75 :: ('MESH:D001927', 'Disease') :: ['hyperechoic lesion'] @entity648 :: ('MESH:D001663', 'Chemical') :: ['bilirubin'] @entity1358 :: ('MESH:D002292', 'Disease') :: ['adenosquamous cell carcinoma'] @entity2421 :: ('MESH:D009123', 'Disease') :: ['Hypotonic'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastasis'] @entity85 :: ('MESH:D009140', 'Disease') :: ['enlarged and deformed papilla']
@entity1358 :: (MESH:D002292,Disease) :: ['Adenosquamous cell carcinoma']
