title: Synchronous presentation of ampullary adenocarcinoma and common bile duct cancer: report of a case and review of literature.
abstract: BACKGROUND
  Ampullary adenocarcinomas and bile duct cancers represent a very small minority of all gastrointestinal malignancies. Synchronous presentation of both malignancies is extremely rare.
  
  
  METHODS
  We report a case of a 76-year-old male who presented with painless jaundice. His work-up showed an ampullary mass and a separate common bile duct stricture. Attempted endoscopic resection established the diagnosis of ampullary adenocarcinoma. Pathologic examination of the Whipple specimen identified a separate focus of bile duct cancer.
  
  
  CONCLUSIONS
  Synchronous presentation of an ampullary mass and separate distal bile duct stricture, especially in elderly patients, should raise concern for both lesions representing malignancies. In the absence of conclusive evidence for survival advantage in resected early stage ampullary and biliary cancers, close observation should be considered a valid alternative to adjuvant chemotherapy and radiation.
authors.affiliation: Section of GI, Tumor and Endocrine Surgery, Department of Surgery, University of Colorado at Denver, Aurora, CO 80045, USA.
authors.forename: Max V
authors.initials: MV
authors.lastname: Wohlauer
authors.forename: Martine C
authors.initials: MC
authors.lastname: McManus
authors.forename: Brian
authors.initials: B
authors.lastname: Brauer
authors.forename: Jeremy
authors.initials: J
authors.lastname: Hedges
authors.forename: Csaba
authors.initials: C
authors.lastname: Gajdos
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000368:Aged; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004379:Duodenal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis*