Multifocal biliary carcinoma; whether synchronous or metastatic: A need to conquer

Multiple synchronous primary carcinoma involving gall bladder, liver and common bile duct are rare difficult to differentiate with hepatic extrahepatic metastasis from single primary. Radiological features, molecular landscape, even integrated mutational profiling not of much help. We describe a case 48-year-old male who presented jaundice follow up CT scan raised the suspicion bladder metastasis. Peroperative frozen section examination revealed adenocarcinoma involvement cystic margin; however revised margin was free tumor invasion. Final histopathology on resected multifocal adenocarcinoma, while histomorphology nodule consistent cholangiocarcinoma. Common one focus had also cut margins were negative form malignancy. In view different morphology tumor, no continuity three tumors large, firm, non umblicated nodule, diagnosis multiple suggested.