A case of synchronous double cancer of the distal bile duct and papilla of Vater

Abstract

A 81-year-old man saw his doctor with complaints of tiredness and bilirubinuria. Blood test showed the elevation of total bilirubin and hepatobiliary enzymes. CT scan showed obstruction and wall thickening at distal bile duct. He was referred to our hospital for treatment of obstructive jaundice and further examination. He was diagnosed as distal bile duct cancer. There was no abnormal macroscopic finding at the papilla of Vater. He underwent subtotal stomach-preserving pancreaticoduodenectomy. Pathological diagnosis showed poorly differentiated adenocarcinoma at the bile duct and well differentiated adenocarcinoma at the papilla of Vater. Although atypical epithelium as BilIN1-2 presented between the two lesions, he was diagnosed as double cancer of the distal bile duct and papilla of Vater because of the difference of histological and immunostaining results. This was a rare case of double cancer of the bile duct and papilla of Vater.