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      Gall Bladder Carcinoma with Ampullary Carcinoma: A Rare Case of Double Malignancy

      case-report

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          Abstract

          Simultaneous double cancers in the biliary system are rare. Most are associated with pancreaticobiliary maljunction (PBM). However, it can occur in patients without PBM. Differentiation between these events is important since these two mechanistic origins imply different stages of disease, as well as different subsequent treatments and prognoses. Herein, we report a case of ampullary carcinoma associated with gall bladder carcinoma diagnosed nonoperatively and palliated with biliary metal stenting.

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          The risk of upper gastrointestinal cancer in familial adenomatous polyposis.

          Francis Giardiello, A Tersmette, Chris Booker … (1992)
          Adenomas with potential for malignancy occur frequently in the upper gastrointestinal tract of patients with familial adenomatous polyposis. However, an assessment of relative risk of upper gastrointestinal cancer in patients with adenomatous polyposis has never been performed. Therefore, the incidence rate of upper gastrointestinal cancer in patients with familial adenomatous polyposis in The Johns Hopkins Registry was compared with the rate of the general population through person-year analysis with adjustment for demographics. There was an increased relative risk of duodenal adenocarcinoma (relative risk, 330.82; 95% confidence limits, 132.66 and 681.49; P less than 0.001) and ampullary adenocarcinoma (relative risk, 123.72; 95% confidence limits, 33.65 and 316.72; P less than 0.001). No significant increased risk was found for gastric or nonduodenal small intestinal cancer. These results indicate that periodic surveillance of the upper gastrointestinal tract for duodenal and periampullary cancer is needed in patients with familial adenomatous polyposis. Prophylactic duodenectomy is a consideration when large adenoma(s) with high-grade dysplasia are identified but awaits risk benefit analysis.
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            Evidence for adenoma-carcinoma sequence in the duodenum of patients with familial adenomatous polyposis. The Leeds Castle Polyposis Group (Upper Gastrointestinal Committee).

            Leslie C. Costello, Manoel Penna, I Talbot … (1994)
            To explore the association between duodenal adenoma and carcinoma in patients with familial adenomatous polyposis (FAP). A multicentre survey of 1262 patients with FAP yielded 47 cases of duodenal cancer. The association between adenoma and cancer was assessed in these cases. Adenomatous tissue was found within duodenal cancer in 29 of 44 (66%) patients with FAP and in mucosa adjacent to duodenal cancer in 31 of 42 (73%) such patients. Adenomas were found as a component of, or adjacent to, duodenal cancer in 38 of 45 (84%) patients. These observations support the existence of the adenomacarcinoma sequence in the duodenum of patients with FAP. Factors associated with malignant change included villous histology, moderate or severe dysplasia, and the presence of stage IV duodenal polyposis.
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              Carcinoma arising in the wall of congenital bile duct cysts.

              Yuuki Watanabe, T. Kobayashi, T Todani … (1979)
              The incidence of carcinoma arising in the wall of the congenital bile duct cysts is much higher than previously assumed. The authors report 4 such cases of primary and secondary carcinomas and review their clinical features through the similar 59 cases in the literature. Of the 63 cases, the average age was much younger, at least several decades, compared with cases of extra-hepatic carcinoma without bile duct cysts. The female-male ratio was 2.5:1. Racial preponderance was also observed, namely, the majority were Japanese. Additionally, many patients previously received various internal drainage procedures, especially choledochocystoduodenostomy. As the treatment, primary excision of the extrahepatic bile duct cyst seems to give the best results because it can avoid ascending cholangitis and prevent development of carcinoma. However, carcinoma still can arise in the intrahepatic bile duct cyst, which cannot be removed at the present time.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Palliat Care
                Journal ID (iso-abbrev): Indian J Palliat Care
                Journal ID (publisher-id): IJPC
                Title: Indian Journal of Palliative Care
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0973-1075
                ISSN (Electronic): 1998-3735
                Publication date (Print): Jan-Apr 2013
                Volume: 19
                Issue: 1
                Pages: 64-66
                Affiliations
                [1]Department of Gastroenterology, SGPGIMS, Lucknow, India
                [1 ]Department of Pathology, SGPGIMS, Lucknow, India
                Author notes
                Address for correspondence: Dr. Praveer Rai; E-mail: praveer_rai@ 123456yahoo.com
                Article
                Publisher ID: IJPC-19-64
                DOI: 10.4103/0973-1075.110240
                PMC ID: 3680842
                PubMed ID: 23766598
                SO-VID: b5c86692-8840-436c-a08e-0db71dcc64c5
                Copyright © Copyright: © Indian Journal of Palliative Care
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: ampulla of vater,double cancer,extrahepatic biliary obstruction,gall bladder carcinoma,periampullary growth
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: ampulla of vater, double cancer, extrahepatic biliary obstruction, gall bladder carcinoma, periampullary growth

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