CASE OF SYNCHRONOUS HEPATOBILIARY TUMOUR; DIAGNOSTIC DILEMMA

Abstract

Synchronous biliary tract tumours are very rare. Synchronous double cancers of the extrahepatic bile duct with-out abnormal pancreatobiliary junction are extremely rare, and to date only 4 cases have been reported in the English literature [1-3]. Until now less than 10 cases have been reported all over the world. Usually, the coexistence is attributed to abnormal pancreatobiliary junction [4-6], local spread or metastasis or de novo. In cases apart from anomalous pancreatobiliary junction, p53 mutations have been associated with simultaneous cancers. Contrast enhanced tomography is done as the initial investigation and FDG-PET is increasingly being used in the staging work up. When there is a suspicion of periampullary growth on cross sectional imaging, side viewing scopy is done to evaluate the lesion and take biopsies. The case presented here is interesting as PET showed metabolically active lesions in the the gall bladder and periampullary region, the latter being subtle on endoscopy.