Multiple Carcinomata Associated with Anomalous Arrangement of the Biliary and Pancreatic Duct System

Abstract

Two rare cases of multiple neoplasms occurring in association with anomalous arrangement of the pancreatobiliary duct system (PBD) are reported. Ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography revealed cholecystic tumor in the first case, and multiple choledochocholecystic tumors in the second case. In the first case, pancreatic tumor was discovered two years after cholecystectomy. In the second case, a pancreatic tumor was discovered incidentally in the removed pancreatic head after the operation. The histology of all of these biliary and pancreatic tumors revealed papillary adenocarcinoma in both patients, and additionally small pancreatic endocrine tumors were found in the first case. Postoperative prognosis was comfortably favorable in both patients. In a literature survey, two other cases of double carcinomata associated with anomalous PBD were found, in which the tumors showed the same histology of papillary adenocarcinoma and the postoperative prognoses were also good. These mutual clinicopathological features appear to suggest that this abnormal condition acts as a carcinogenetic risk factor in the pancreatic duct and the biliary duct system, and may finally cause multiple carcinomata in the PBD. Acta Pathol Jpn 40: 755‐763, 1990.

Intraductal papillary-mucinous tumours represent a distinct group of pancreatic neoplasms: an investigation of tumour cell differentiation and K-ras, p53 and c-erbB-2 abnormalities in 26 patients

“…However, the preferential occurrence of mucinous cystic tumours in the distal rather than the proximal pancreas, the high preponderance of female patients as well as the distinctive gross morphology clearly separate these tumours from IPMT (5,37,44,52). Considering the histological and histochemical similarities of many IPMT (especially the malignant ones) with well differentiated papillary-villous colorectal, ampullary and biliary tract tumours (31), and the reported cases with simultaneous involvement of biliary tract, ampulla and pancreas by papillary tumours (21,24,25), it seems possible that some relationship may exist between these groups.…”

Metachronous double cancer of the gallbladder and pancreas associated with pancreaticobiliary maljunction

“…There have been 27 reported cases (including ours) of cancer of the pancreas in patients who had pancreaticobiliary maljunction. Double cancer of the biliary tree and pancreas in patients with pancreaticobiliary maljunction has been reported in seven patients including ours (two cases were triple cancer of the gallbladder, the bile duct, and the pancreas) . (Table 1).…”

Multiple Cancers of the Biliary Tract and Pancreatic Duct after Cholecystectomy for Gallbladder Cancer in a Patient with Pancreaticobiliary Maljunction

“…However, the relationship between pancreatic cancer and PBM remains controversial and unclear. In addition, cases of double cancer of the biliary system and the pancreas is extremely rare in patients with PBM (8,(10)(11)(12), despite occasional reports of multiple cancers of the biliary system in patients with PBM (3)(4)(5). The present case suggested that careful attention should be paid to the whole pancreaticobiliary system with regard to carcinogenesis, however, further case studies are needed.…”

“…The definitive distinction between multicentric primary cancers and gallbladder cancer metastases is difficult. Although biliary cancer in patients with PBM is occasionally encountered, pancreatic cancers in patients with PBM are rare (8)(9)(10)(11)(12). Funabiki et al (13) reported that the incidence of pancreatic cancer is higher in patients with PBM than in patients without PBM.…”