title: A case of triple synchronous cancers occurring in the gallbladder, common bile duct, and pancreas.
abstract: We report a 74-year-old man with triple synchronous cancers occurring in the gallbladder, common bile duct, and pancreas. The patient had consulted a nearby physician because of epigastralgia and icterus. On September 30, 1997, the patient was admitted to our department for further evaluation and treatment. Abdominal computed tomography (CT) showed dilatation of the common bile duct, cystic duct, and intrahepatic bile duct, and swelling of the gallbladder. On CT, the wall of the distal common bile duct was thick and a low-density mass was detected on the left side. Cholangiography, performed via percutaneous transhepatic cholangiodrainage (PTCD), revealed stenosis of the distal common bile duct. Endoscopic retrograde pancreatography (ERP) showed marked dilatation of the main pancreatic duct. On October 17, 1997, pancreatoduodenectomy was performed under the diagnosis of carcinoma of common bile duct and pancreas. Histopathological examination revealed poorly differentiated tubular adenocarcinoma of the common bile duct, well-differentiated tubular adenocarcinoma of the gallbladder, and mucinous cystadenocarcinoma of the pancreas. These three tumors were histopathologically different. Moreover, p53-positive nuclei were recognized only in the pancreas tumor. These findings suggested that the oncogenic mechanisms of multiple synchronous cancers were not the result of only abnormal DNA reparative mechanisms.
authors.affiliation: Department of Surgery, Juntendo Izunagaoka Hospital, Juntendo University School of Medicine, 1129 Nagaoka, Izu-nagaoka-cho, Tagata-gun, Shizuoka 410-2295, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sato
authors.forename: Takeo
authors.initials: T
authors.lastname: Maekawa
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Yabuki
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Tamasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maekawa
authors.forename: Keizo
authors.initials: K
authors.lastname: Kudo
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sengoku
authors.forename: Ikukyo
authors.initials: I
authors.lastname: Kawa
authors.forename: Ryo
authors.initials: R
authors.lastname: Wada
authors.forename: Michio
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D003138:Common Bile Duct Neoplasms / Q000473:pathology*; D018282:Cystadenocarcinoma, Mucinous; D005706:Gallbladder Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*