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Synchronous cholangiocarcinoma and gallbladder cancer: A rare presentation
Puppala Venkata Sagar1, Kanchustambam Subba Rao2
1MBBS, MS, Senior Specialist/Jr. Consultant, Department of Surgical Gastroentrology & HPB, Transplant, Care Hospitals, Visakhapatnam, Andhra Pradesh, India
2 MBBS, DNB, FRCS, ASTS, Senior Consultant, Department of Surgical Gastroentrology & HPB, Transplant, Care Hospitals, Visakhapatnam, Andhra Pradesh, India

Article ID: 100075Z04PS2018
doi:10.5348/100075Z04PS2018CI

Address correspondence to:
Venkata Sagar Puppala,
49-36- 16/5, F2, Galaxy Apartment,
NGGO's Colony, Akkayyapalem, Sakhapatnam,
Andhra Pradesh-530016, India

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How to cite this article
Sagar PV, Rao KS. Synchronous cholangiocarcinoma and gallbladder cancer: A rare presentation. Int J Hepatobiliary Pancreat Dis 2018;8:100075Z04PS2018.


ABSTRACT
Introduction: Synchronous biliary tree and gallbladder cancers are rarely encountered and reported in the literature. In this article, we report an extremely rare presentation of a patient with distal common hepatic duct (CHD), proximal common bile duct (CBD) and gallbladder cancer associated with anomalous pancreaticobiliary duct junction (APBDJ) as primary tumors.
Case Report: A 40-year-old male referred to us with RUQ pain, fever, jaundice and pruritis since two weeks. PET-CT showed hypermetabolic polypoid mass in the fundus of gallbladder and a periportal node. ERCP was done but guide wire could not be passed beyond mid CBD. The findings were neoplastic mass in fundus of the gallbladder with pericholedochal lymphadenopathy. There was another neoplastic mass in the CBD. An extended cholecystectomy with extrahepatic CBD excision with a pancreaticoduodenectomy with radical lymphadenectomy was performed. Intra-operative ultrasonography was done to rule out other lesions in the pancreas and liver. Histopathological examination revealed well differentiated adenocarcinoma of gallbladder and adenocarcinoma of proximal CBD and distal CHD, stagging pT2 pN0 pMx.
Conclusion: Synchronous extra hepatic and gallbladder tumors are extremely rare, their etiopathogenesis has not been properly understood and defined. Fujii et al. reported that 62.5% of synchronous double cancers and 100% of metachronous double cancers of the biliary tract were associated with PBM. Biliary cancers with PBM are thought to develop multicentrally, due to the effect of pancreatic juice reflux on the mucosa of the biliary tract.

Keywords: Adenocarcinoma, Anomalous pancreaticobiliary maljunction, Biliary tree, Synchronous


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Author Contributions
Puppala Venkata Sagar – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kanchustambam Subba Rao –Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this case report.
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2018 Puppala Venkata Sagar et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.