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Arch Surg. 1946;53(6):627-634. doi:10.1001/archsurg.1946.01230060638002.
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TUMORS obstructing the common and hepatic bile ducts include primary neoplasms of the ducts and of the ampulla and carcinoma of the pancreas secondarily involving the common duct. Benign adenomas, polyps and congenital cysts may involve the ducts; however, carcinoma is relatively more frequent, and of this group carcinoma of the ampulla of Vater is perhaps the commonest.1 All these primary lesions are extremely rare. Kelznack found two instances in four thousand, five hundred and seventy-eight routine postmortem examinations, and McGlinn found five in nine thousand. Of twenty-two thousand operations on the biliary tract at the Mayo Clinic, only forty-one were for carcinoma of the bile ducts.2 The lesion occurs more frequently among men, and in about half of the cases it is associated with stones in the gallbladder or in the bile ducts. Primary carcinoma most frequently occurs at the junction of the cystic and common ducts


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