Adenomyoma of the papilla of Vater

An adenomyoma of the papilla of Vater that caused biliary obstruction resulted in an extensive surgical resection because of the clinical and roentgenographic suspicion of carcinoma. Benign neoplasms of the papilla and extrahepatic bile ducts are exceedingly rare, but their recognition is of clinical importance. Histologically, the adenomyoma, characterized by lobules of ducts and ductules with interlacing bundles of smooth muscle, was similar to the adenoleiomyomatous hamartoma of the intestines and to lesions of the gallbladder or extrahepatic ducts known as adenomyomas or adenomyomatous hyperplasia. The presumed rapid recent growth of the present lesion, as roentgenographically documented by the recent onset of dilatation of the common bile duct in an elderly woman, as well as the lack of gallstones or inflammatory disease of the biliary tract, might support the contention that the present lesion was neoplastic. On the other hand, the possibility that the lesion represents a hamartoma or diverticulosis of the saccules of Beale cannot be excluded.