Resection of triple synchronous cancers: A case report

We herein present a case of synchronous triple cancer, which was successful ly resected in a curative manner. These cancers consisted of primary duoden al, pancreatic and lung cancers, which were diagnosed in an asymptomatic 74 year-old male, who was referred to our department on December 14, 1996. On admission, his laboratory data showed no abnormality, including tumor mark ers (CEA 1.0, CA 19-9 1.0, AFP 8.1 U/ml), but he did show an impaired pulmo nary function (FEV1.0: 57%). Upper gastrointestinal endoscopy showed a smoo th surfaced duodenal tumor measuring 4cm in size. The second tumor was foun d at the head of the pancreas by computed tomography (CT), showing a hyperv ascular mass measuring 3.0cm, along with neighboring multiple cysts. In end oscopic retrograde cholangiopancreatography (ERCP), marked mucous secretion was observed through the papilla, while a filling defect was found in the dilated pancreatic duct. In a routine chest X-ray, a third tumor, which mea sured 1.5cm in diameter, was recognized in the right upper lobe of the lung , and a moderately differentiated squamous cell carcinoma was also detected by a percutaneous CT guided biopsy. The pancreatic and duodenal tumors wer e surgically resected by a pancreatoduodenectomy (Stage I) in January 1997 and, 5 months later, a lung tumor underwent partial resection (Stage I). Th is patient tolerated these surgical procedures well and presently leads a n ormal, healthy life after discharge. In summary, a successful resection of synchronous triple cancers, which has never been previously reported in thi s specific combination, is described.