title: Two synchronous malignant tumors of the pancreas: a case report.
abstract: BACKGROUND
  Only a limited number of multiple synchronous primary malignancies of the pancreas have been reported in the medical literature. We report a case of two solid malignant tumors of the pancreas diagnosed preoperatively.
  
  
  METHODS
  We describe a 65-year-old Sri Lankan woman who presented with progressive obstructive jaundice. Initial contrast-enhanced computed tomography imaging detected a malignant tumor at the tail of her pancreas. A second tumor of the pancreatic head was detected with integrated imaging using multidetector computed tomography and multimodal magnetic resonance imaging. She underwent total pancreaticoduodenectomy and splenectomy. Gross examination of the specimen confirmed the presence of two separate tumors. Histology of the ampullary tumor showed pancreatic-type adenocarcinoma and the tumor in the tail of her pancreas showed a colloid-type adenocarcinoma.
  
  
  CONCLUSIONS
  The possibility of multiple primary malignant solid tumors of different types with malignant potential has to be considered even without background pathology when managing multiple tumors in the pancreas.
authors.affiliation: Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka. supun85@gmail.com.
authors.forename: W S L
authors.initials: WS
authors.lastname: De Silva
authors.affiliation: Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Colombo, Sri Lanka.
authors.forename: A A
authors.initials: AA
authors.lastname: Pathirana
authors.affiliation: Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Colombo, Sri Lanka.
authors.forename: I
authors.initials: I
authors.lastname: Prematilleke
authors.affiliation: Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Colombo, Sri Lanka.
authors.forename: S A P D
authors.initials: SA
authors.lastname: Rajapakse
authors.affiliation: Department of Radiology, Asiri Surgical Hospital, Colombo, Sri Lanka.
authors.forename: P S H
authors.initials: PS
authors.lastname: Hettiarachchi
authors.affiliation: Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: D S
authors.initials: DS
authors.lastname: Manawasinghe
authors.affiliation: Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: B K
authors.initials: BK
authors.lastname: Dassanayake
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D064847:Multimodal Imaging; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000473:pathology; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology*; D016577:Pancreaticoduodenectomy; D013156:Splenectomy; D016896:Treatment Outcome
keywords: Ampullary carcinoma; Synchronous primary pancreatic carcinoma; Total pancreaticoduodenectomy