Double Primary Cancer of the Gallbladder and the Ampulla of Vater in Association with Adenoma-Carcinoma Sequence

ABSTRACT

An adenoma is a rare benign tumor arising in the extra-hepatic biliary duct. Adenocarcinomatous changes are often observed in the background of an adenoma. Double or triple cancer with an adenoma and adenocarcinoma in the biliary tract can be the crucial evidence of the adenoma-carcinoma sequence. We first performed laparoscopic surgery on a 63-year old male patient complaining of pain in the right upper quadrant of the abdomen and jaundice a week earlier, which was initially diagnosed by a radiologist as a sessile polyp of the gallbladder along with stones in the gallbladder and the common bile duct. A mass was found in the distal common bile duct and ampullary area during intraoperative choledochoscopy. The frozen sections taken during surgery indicated a cancer or dysplasia in the gallbladder and the distal common bile duct. The patient underwent a pylorus-preserving pancrea-toduodenectomy. The final diagnosis was a double primary can-cer originating in the gallbladder and the ampulla of Vater with an adnocarcinoma in an adenoma. We report this case with review of the relevant literature.