Synchronous Triple Primary Cancers - Liver, Gallbladder and Pancreas

We report here on a case of synchronous triple primary cancers that occurred in the liver, gall bladder and pancreas. A 69-year-old man who presented with symptoms of diarrhea, poor oral intake and dyspepsia was referred to our hospital. The diagnostic images showed a gall bladder mass (about 2cm in size), a pancreas head mass (2.7cm in size) and a liver mass (about 4cm in size) in segment 7. On positron emission tomography, the liver mass did not show a hypermetabolic uptake. We could not confirm a liver mass between the metastatic lesion and the hepatocellular carcinoma, and so we performed liver biopsy, which revealed hepatocellular carcinoma. Pylorus-preserving pancreaticoduodenectomy, extended cholecystectomy and liver wedge resection of segment 7 were performed. The biopsy showed gall bladder adenocarcinoma, pancreas ductal adenocarcinoma and hepatocellular carcinoma. Many multiple primary malignant neoplasms have previously been reported on, however, reports in the medical literature on synchronous multiple primary cancers occurring in the hepatobiliary and pancreas systems are very rare.