A Synchronous Intraductal Papillary-Mucinous Carcinoma Arising in the Accessory Pancreatic Duct and Extrahepatic Bile Duct Carcinoma

A 78-year-old woman was admitted to our hospital due to jaundice and liver dysfunction. As a result of imaging studies, we diagnosed lower bile duct carcinoma and minor papilla carcinoma, and performed pancreaticoduodenectomy in January, 2009. Resected specimens showed multiple cysts in the accessory pancreatic duct region, and we diagnosed lower bile duct carcinoma and pancreatic duct carcinoma in the accessory pancreatic duct region with lymphatic node metastasis on histopathological examination. Adjuvant chemotherapy and sequential chemotherapy due to suspicious local recurrence was performed, but halted decrease in QOL due to ascites and hepatic coma. About 5 years after surgery, she died of liver cirrhosis without enlargement of local recurrence or distant metastasis. Because she survived for a long-term period, we performed histological re-examination with immunostaining. It revealed pancreatic cancer was recognized intraductal papillary-mucinous carcinoma. Intraductal papillary-mucinous carcinoma arising in the accessory pancreatic duct is rare. Furthermore, simultaneous occurrence with extrahepatic bile duct carcinoma is a very rare entity, so we report our case.