Wohlauer Max V, McManus Martine C, Brauer Brian, Hedges Jeremy, Gajdos Csaba
Section of GI, Tumor and Endocrine Surgery, Department of Surgery, University of Colorado at Denver, Aurora, CO 80045, USA.
JOP. 2012 Sep 10;13(5):536-9. doi: 10.6092/1590-8577/836.
Ampullary adenocarcinomas and bile duct cancers represent a very small minority of all gastrointestinal malignancies. Synchronous presentation of both malignancies is extremely rare.
We report a case of a 76-year-old male who presented with painless jaundice. His work-up showed an ampullary mass and a separate common bile duct stricture. Attempted endoscopic resection established the diagnosis of ampullary adenocarcinoma. Pathologic examination of the Whipple specimen identified a separate focus of bile duct cancer.
Synchronous presentation of an ampullary mass and separate distal bile duct stricture, especially in elderly patients, should raise concern for both lesions representing malignancies. In the absence of conclusive evidence for survival advantage in resected early stage ampullary and biliary cancers, close observation should be considered a valid alternative to adjuvant chemotherapy and radiation.
壶腹腺癌和胆管癌在所有胃肠道恶性肿瘤中占比极小。两种恶性肿瘤同时出现极为罕见。
我们报告一例76岁男性患者，其表现为无痛性黄疸。检查显示有一个壶腹肿物以及一个单独的胆总管狭窄。尝试进行内镜切除后确诊为壶腹腺癌。对Whipple手术标本的病理检查发现了一个单独的胆管癌病灶。
壶腹肿物与单独的远端胆管狭窄同时出现，尤其是在老年患者中，应警惕这两种病变均为恶性肿瘤。在缺乏早期切除的壶腹癌和胆管癌生存获益的确凿证据的情况下，密切观察应被视为辅助化疗和放疗的有效替代方案。
