A Case of Double Synchronous Common Bile Duct Cancer and Pancreas after 7 Postoperative Recurrence-Free Years of Survival

A 69-year-old man was found in enhanced abdominal computed tomography and magnetic resonance imaging to have an enhanced thickened inferior bile duct and an enhanced tumor in the pancreatic head. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance (MR) MRCP showed a stenotic common bile duct but a normal pancreatic duct and no anomalous pancreaticobiliary ductal arrangement. Based on a diagnosis of advanced inferior bile duct carcinoma with lymph node metastasis, we conducted subtotal stomach-reserving pancreatoduodenectomy. Macroscopically, resected material showed a tumor in the common bile duct and in the pancreas head. Histopathologically, moderately differentiated tubular adenocarcinoma was found in the common bile duct and pancreas head, but the two tumors were somewhat distinct and had no continuation, yielding a diagnosis of double cancer of the bile duct and pancreas. A pancreatic fistula was identified postoperatively. Discharged on postoperative day 38, the man is doing well, without signs of recurrence 7 years later.