A Case Report of Synchronous Triple Early Carcinomas in the Stomach, Papilla of Vater and Rectum

We experienced a case of synchronous triple early cancers of the stomach, papilla of Vater and rectum. A 57-year-old man was admitted to the hospital because of detection of pancreatic cyst. Preoperative alimentary tract examination revealed a shallow depressed lesion of the stomach, a submucosal tumor-like bulge on the papilla of Vater and a protruding mass with a central ulceration in the upper rectum. Histopathologically each of the three lesions was identified as carcinoma. Total gastrectomy, pancreatoduodenectomy and low anterior resection were performed at the same time. The gastrointestinal tract was reconstructed with Roux Y, Child manner and direct end-to-end color-colostomy. The final pathological report indicated all three of the carcinomas were limited to the submucosa, and regional lymph nodes were negative for cancer. By immunohistochemical staining with anti-p53 monoclonal antibody, expression of p53 was detected in the rectal cancer lesion. The postoperative course was uneventful except for leakage of the pancreaticojejunostomy. The patient's condition is presently stable without signs of relapse. A case of simultaneously resected triple primary early cancer has rarely been reported, this is the second case reported in Japan.