# A Surgical Case of Synchronous Double Cancer of the Pancreatic Tail and the Distal Bile Duct

## TL;DR

A 60-year-old woman with simultaneous bile duct and pancreatic cancers underwent surgery and chemotherapy, but the cancers later spread and proved fatal.

## Contribution

This paper presents a rare case of synchronous double cancer involving the distal bile duct and pancreatic tail, highlighting diagnostic and treatment challenges.

## Key findings

- The patient had two distinct tumors in the distal bile duct and pancreatic tail with no histological continuity.
- Surgical resection followed by chemotherapy was performed, but metastases occurred within two years.
- The case emphasizes the rarity and complexity of synchronous bile duct and pancreatic cancers.

## Abstract

In recent years, there have been many reports of cases of double cancer. This is due to improvements in diagnostic techniques and treatment methods for cancer and the extension of average life expectancy. However, there are few reports of bile duct cancer and pancreatic cancer occurring together.

The patient was a woman in her 60s who presented to our hospital with jaundice. CT revealed a 30-mm hypovascular mass lesion in the pancreatic head and a similar mass lesion in the pancreatic tail. Endoscopic retrograde cholangiopancreatography (ERCP) showed stenosis of the distal bile duct and pancreatic duct (in the pancreatic tail) without evidence of pancreaticobiliary maljunction. Cytological examination of pancreatic juice revealed Class V adenocarcinoma, while endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the pancreatic tail suggested Class III adenocarcinoma. Based on these findings, a diagnosis of double cancer involving the pancreatic head and pancreatic tail was made. The patient underwent neoadjuvant chemotherapy with five cycles of gemcitabine (1200 mg) and nab-paclitaxel (150 mg). Following chemotherapy, she underwent subtotal stomach-preserving total pancreatectomy with left adrenalectomy and splenectomy. Pathological examination of the resected specimen revealed a 2 × 1.5 cm thickened wall in the distal bile duct associated with bile duct stenosis. In addition, a 3.2 × 1.8 cm nodular lesion was identified in the pancreatic tail, which was not contiguous with the thickened wall of the distal bile duct. Histopathological analysis demonstrated moderately differentiated tubular adenocarcinomas in the distal bile duct and the pancreatic tail. Given the absence of continuity between the 2 tumors and the differences in their histological features, the case was diagnosed as synchronous double cancer of the bile duct and pancreas. The postoperative course was uneventful, and the patient was discharged home on postoperative day 43. However, 2 years after surgery, multiple liver, lung, and lymph node metastases were detected. The patient passed away later that year.

We report on the case of a patient with bile duct and pancreatic cancer who underwent surgical resection.