Triple cancer of gallbladder, common bile duct and papilla of Vater: Report of a case and review of literature

Stefano Passoni; Takamune Yamaguchi; Emilie Uldry; Emmanuel Melloul; Nermin Halkic; Alessandra Cristaudi

doi:10.1016/j.ijscr.2021.106469

Triple cancer of gallbladder, common bile duct and papilla of Vater: Report of a case and review of literature

Int J Surg Case Rep. 2021 Dec:89:106469. doi: 10.1016/j.ijscr.2021.106469. Epub 2021 Oct 6.

Authors

Stefano Passoni¹, Takamune Yamaguchi², Emilie Uldry³, Emmanuel Melloul³, Nermin Halkic³, Alessandra Cristaudi⁴

Affiliations

¹ Department of General Surgery, Regional Hospital of Locarno, Via all'Ospedale 1, 6600 Locarno, Switzerland. Electronic address: Stefano.Passoni@eoc.ch.
² Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
³ Department of Visceral Surgery, University Hospital of Lausanne, Rue de Bugnon 46, 1011 Lausanne, Switzerland.
⁴ Department of Visceral Surgery, Regional Hospital of Lugano, Via Tesserete 46, 6903 Lugano, Switzerland.

Abstract

Introduction and importance: Synchronous malignancies of gallbladder and biliary tree are together rare entity whose pathogenesis is yet unknown. We report the case of a triple synchronous cancer of 3 distinct location: gallbladder, common bile duct (CBD) and papilla of Vater.

Case presentation: An 84-years-old woman, was admitted to our Hospital with clinics features of obstructive jaundice. Dilatation of the biliary tree and CBD without evidence of gallstones was seen at US. CT scan confirmed distal CBD obstruction. An endo-US showed a nodule of the head of pancreas infiltrating the lower CBD. Finally, hepatic-MRI displayed a gallbladder malignancy with invasion of CBD. Preoperative staging showed 3 diagnostic suspicions: carcinoma of CBD on CT, pancreatic carcinoma on endo-US and malignancy of gallbladder on MRI. A cephalic duodenopancreatectomy and radical gallbladder resection was performed. Final pathology revealed 3 distinct location of moderately differentiated adenocarcinomas: Gallbladder, CBD and Vater's papilla. Microscopic examination didn't detect any direct continuity between the 3 tumors. Metastases were identified in the pancreaticoduodenal, peri-hepatic and peri-gastric lymph nodes.

Clinical discussion: Literature displayed 22 cases of synchronous malignancies of gallbladder and CBD and 1 case of triple cancer with associated Vater's papilla carcinoma. In most of these cases, an association with an anomalous pancreatic-bile duct junction was reported. Although the real incidence remain unknown, it was reported to occur in 5-10% of CBD cancers.

Conclusion: Suspicion of such combination of cancer should be remembered, especially when preoperative investigations don't allow a precise localization of tumor in the biliary tree.

Keywords: Biliary tract cancer; Case report; Gallbladder disease; Hepatic and pancreatic surgery; Multiple cancer.