[Carcinoid of Vater's papilla. The authors' own experience]

Carcinoid tumours of the papilla of Vater, like all those of the gastroenteric tract, belong to the PUD system: in fact they excrete different amines and polypeptidic hormones that cause articulated and complex clinical features. We describe the clinical picture of a non secreting carcinoid tumour in a patient suffering from cholelithiasis in who jaundice has appeared after video-laparocholecystectomy; ERCP detected a papillary neoplasia which proved to be a carcinoid tumour at immunohistochemical investigation. The patient was submitted to surgical removal of the neoplasia by the trans-duodenal way. This kind of operation was chosen considering the small dimension of the tumour, the absence of lymph nodal and hepatic involvement and the elevated risk of pancreaticoduodenectomy. Eight months later hematic gastrine, NSE and total body scintigraphy with octreotide have shown normal values and the patients is in good clinical condition. The diagnosis of these tumours is always difficult when the typical hormonal syndrome is not present. The prognosis of this kind of tumours is better than others of the gastrointestinal tract due to the early symptoms (jaundice), and, consequently, of the treatment. A strict follow-up is recommended in these patients because a resumption of the tumour could also appear many years after the surgical intervention.