Fat is present in tumours like lipoma or teratoma, but we could not explain the fat deposition, peritumoural and distant to the tumour. This fat was well encapsulated and we removed the peritumoral quantity intact with the tumour, but we removed the fat piece meal around the portal traid. The gallbladder along with the fatty clumps were removed during hepatectomy. We were apprehensive about Inhibitors,research,lifescience,medical leaving behind small macroscopic amount of fat around

the portal triad and its effect on recurrence of the tumour. We have followed up for 24 months and the patient is tumour free till now. Table 1 Reports of pancreatic and hepatic MCNs Hepatic MCN is found in about 5% of cystic hepatic lesions (2). It is common in women like its pancreatic counterpart, commonly symptomatic and single. Both the pathologists concurred that the tumors in the pancreas and the liver were histologycally similar and were in favour of the diagnosis of simultaneous occurrence of mucinous cystic neoplasm in Inhibitors,research,lifescience,medical two organs. One of the proposed pathogenesis is these tumours are derived from the detached cells covering the gonads which is in close proximity of the liver and pancreas in the fetal period (2). But this fails to explain the presence of these tumours in men and in tumours Inhibitors,research,lifescience,medical where there is no ovarian-like stroma. Conclusions Liver and pancreatic mucinous cystic neoplasm occurring together is extremely rare.

The presence of these tumors in a male patient puts the current hypothesis of pathogenesis in doubt. The unusual amount of fat occurred probably as a response to the tumour and it is not involved with the recurrence of the tumour as appears from the followup of the discussed patient. Inhibitors,research,lifescience,medical Acknowledgements Disclosure: The authors declare no conflict of

interest.
Patients with pancreatic cancer are often diagnosed after progression to Inhibitors,research,lifescience,medical a locally advanced or metastatic stage. Medical students are taught to recognize the classic “painless jaundice” from malignant obstruction of the distal common bile duct in the setting of this dreaded disease, which continues to have dismal about survival rates of only 5% (1). Endoscopic placement of a biliary stent is a standard palliative measure for patients with metastatic disease, to relieve jaundice and buy ABT-199 associated pruritus during the last months of life. Self-expanding metal stents (SEMS) have been found to be more cost-effective than plastic stents for patients whose life expectancy exceeds 6 months (2). In contrast, for patients who present with resectable disease, a multicenter randomized controlled trial has shown that placement of a biliary stent prior to pancreaticoduodenectomy leads to increased rates of complications, and that these patients should proceed directly to surgery (3). This trial did not address the population of patients who undergo neoadjuvant therapy, in an attempt to downstage locally advanced disease and make curative resection possible.