Gastrin‐secreting tumor of the duodenum (G‐cell apudoma) associated with secondary biliary cirrhosis

A middle‐aged woman with evidence of chronic cholestasis of several years and no previous abdominal surgery was initially thought to have primary biliary cirrhosis. Clinical evaluation disclosed a well‐developed secondary biliary cirrhosis apparently caused by extrahepatic obstruction due to a 1 × 2 cm neoplasm of the periampullary duodenum. Electron microscopy and immunofluorescent studies showed the neoplasm to be a G‐cell adenoma. Wide local excision has resolved the biliary obstruction. Benign or slow‐growing duodenal tumors, if they involve the ampulla of Vater, may produce prolonged partial extrahepatic obstruction and secondary biliary cirrhosis.