Abstract
A 79-year-old man was referred to his doctor because of epigastralgia and upper gastrointestinal fiberscopy showed a tumor of papilla of Vater (PV). After admission to our hospital, Abdominal CT showed not only a tumor of PV but elevated leision of the common bile duct (CBD) and mass in the main pancreatic duct (MPD). Under a diagnosis of triple cancer of PV, CBD and pancreas, pancreatoduodenectomy was performed. Histopathologically, all of the three lesions were papillary adenocarcinoma. The tumor of CBD had extensive intraepithelial spread toward the PV but separate from the tumor of PV. On the other hand, the tumors of PV and pancreas were directly communicated with intraepithelial carcinoma. On immunohistochemical staining, MIB-1 labeling indexes differed between the tumors of the CBD and PV or pancreas. We thus diagnosed double cancer of the CBD and PV. To our knowledge, only 9 cases (including our case) of synchronous double cancer involving the CBD and PV have been reported in the literature.
