A Resected Case of Synchronous Intraductal Papillary Mucinous Adenocarcinoma and Bile Duct Carcinoma

Jiro Ohuchida, Kazuo Chijiiwa, Masahide Hiyoshi, Motoaki Nagano, Masahiro Kai, Kazuhiro Kondo, Shuichiro Uchiyama*, Kiyoka Moriguchi** and Yushiro Asada**

Department of Surgery 1, Department of Pathology 2* and Department of Pathology 1**, Miyazaki University School of Medicine

A 76-year-old man referred for jaundice and upper right quadrant pain was found in computed tomography (CT) and MRCP to have a 3 cm multilocular cystic lesion in the pancreas head. The bile duct close to the pancreatic lesion was stenotic and the wall had thickened. Endoscopy showed an enlarged orifice of the papilla Vater with mucous secretion. The multilocular cystic lesion communicating with the main pancreatic duct (MPD) was observed in the pancreas head by ERCP and the MPD was dilated and filled with mucin. The pathological diagnosis of the biopsy specimen from the stenotic bile duct lesion was adenocarcinoma. EUS showed thickening of the septums, but no mural nodule. Pylorus-preserving pancreaticoduodenectomy with D2 lymph node dissection was conducted. The definitive pathological diagnosis was carcinoma of the bile duct invading to the subserosal layer and noninvasive intraductal papillary mucinous carcinoma of the pancreas. These were separately presented and diagnosed as synchronous double cancer. Clinical stage was IVa according to paraaortic lymph node metastasis (16b1). Since, to our knowledge, only 1 case of intraductal papillary mucinous carcinoma associated with bile duct carcinoma has been reported in the literature, we report our case in detail.

Key words
intraductal papillary mucinous neoplasm, bile duct carcinoma, double cancer

Reprint requests
Kazuo Chijiiwa Department of Surgery 1, Miyazaki University School of Medicine
5200 Kihara, Kiyotake, Miyazaki, 889-1692 JAPAN

Accepted
November 30, 2005

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