We report a case of quadruple cancer of 3 organs in which mucinous cholangiocarcinoma and gastric remnant cancer developed pastoperatively for early gastric cancer and bile duct cancer. A 69-year-old man had undergone distal gastrectomy for early gastric cancer at age 54 (IIc tumor, moderately differentiated tubular adenocarcinoma, m), and hilar hepatectomy with caudate lobectomy for bile duct cancer at age 63 (papillary tumor, 2.0 x 2.0cm , well-differentiated tubular adenocarcinoma, ss, n0, stage II). He was admitted for anterior chest and upper abdominal discomfort and an increase in serum CA19-9. Early gastric cancer detected at the remnant stomach necessitated endoscopic mucosal resection (0-1 type, well-differentiated tubular adenocarcinoma, m). US, CT, and MRI showed a tumor from the lateral segment of the liver to the anterior mediastinum. Preoperative diagnosis was liver metastasis of bile duct cancer, necessiatating lateral segmentectomy with partial resection of the diaphragm, sternum, and pericardium. Macroscopic findings showed a tumor 7.0 x 5.0 cm with a yellowish-white lobular cut surface. The pathological diagnosis was mucinous cholangiocarcinoma (T2 : diaphragm, sternum, pericardium, N0, M0, Stage III). He died 7 months after the last operation due to multiple bone metastases.
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