A Case of Synchronous Triple Cancers of the Stomach, Colon and Duodenum Which was Associated with EBV

Yoshinori Yagi, Akiyoshi Seshimo, Maki Mitsuhashi, Kazuki Aratake, Masaaki Yamatake, Ryoichi Fujita, Koichi Soyama, Shinpei Ogawa and Shingo Kameoka

Department of Surgery II, Tokyo Women's Medical University

A 74-year-old male was admitted to our hospital with a chief complaint of melena. The gastroendoscopy revealed an early gastric cancer (IIa+IIc) at the posterior wall of the antrum, and an advanced duodenal cancer (Borrmann type-2). Furthermore, the colonoscopy revealed advanced colon cancer of the ascending colon. The diagnosis was synchronous triple cancer of the stomach, duodenum and ascending colon. We performed a distal gastrectomy with wide resection of the duodenal bulb and partial resection of the ascending colon. Pathological examination of the resected specimen revealed papillary adenocarcinoma of the stomach, and moderately differentiated adenocarcinoma of the duodenum and ascending colon. The duodenal cancer showed lymphoid stroma and was LMP-1 and EBER positive. Thus, we suspected the cancer was associated with Epstein-Barr virus (EBV). Although primary gastric cancer associated with EBV has been described in the literature, primary duodenal cancer has never been reported. Moreover, this is the 11th case reported in Japan of synchronous triple cancer which concluded the primary duodenal cancer.

Key words
synchronous triple cancer, primary duodenal cancer, Epstein-Barr virus (EBV)

Reprint requests
Yoshinori Yagi Department of Surgery II, Tokyo Women's Medical University 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 JAPAN

Accepted
March 31, 1999

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