DIFFERENT DISTRIBUTION OF CA19-9 IN CARCINOMAS ARISING IN THE PAPILLAOF VATER - AN IMMUNOHISTOCHEMICAL STUDY

The origin and pathogenesis of the carcinoma of the Vater's papilla we re estimated by immunohistochemically analysing the distribution of CA 19-9 in the tumor tissue. The material comprised surgical specimens fr om 29 patients with carcinoma of the Vater's papilla, 15 with carcinom a of the pancreas, 24 with carcinoma of the bile duct and two with car cinoma of the duodenum. A non-invasive adenomatous component (NAC) was shown to coexist with carcinoma of the Vater's papilla in 14 patients . Besides, normal papilla of Vater from ten autopsy cases were added a s control. The presence of CA19-9 in the tissue was demonstrated by AB C method using a monoclonal antibody. The epithelia of normal pancreat ic and bile ducts showed diffuse distribution of CA19-9, while at the common channel and the orifice of the papilla it was partially distrib uted. CA19-9 was not demonstrated in the duodenum. The NAC-positive ca rcinoma of the papilla of Vater showed partially distributed CA19-9. I n contrast, NAC-negative carcinoma of the the Vater's papilla and carc inomas of the pancreas and bile duct showed diffuse distribution of CA 19-9. Moreover, the level of serum CA19-9 in most of the patients with NAC-positive carcinoma of Vater's papilla remained within the normal limit, while in patients with NAC-negative carcinoma, or with carcinom a of the pancreas or bile duct, the level was higher. Thus it was spec ulated that NAC-positive carcinoma of Vater's papilla may arise from t he common channel, the orifice of the papilla, or the duodenum acquiri ng antigenicity against CA19-9 during the cancer development. On the o ther hand, NAC-negative carcinoma of the Vater's papilla may originate from the pancreatic or bile ducts.