We report an unusual case of synchronous triple early cancers of the stomach, gallbladder and sigmoid colon. The patient was a 70-year-old man. Gastrointestinal endoscopy at a medical check-up initially revealed early gastric cancer. A thorough preoperative investigation showed a gallbladder tumour and early colon cancer. Endoscopic mucosal resection was performed for the colon cancer. Microscopically, the specimen showed well-differentiated adenocarcinoma involving the submucosal layer. Distal partial gastrectomy (D1) and simple cholecystectomy with lymph node dissection were also performed. The histopathological diagnosis was well-differentiated adenocarcinoma in the stomach (T1, N0, M0; Stage IA) and poorly differentiated papillary adenocarcinoma (T1, N0, M0; Stage I) in the gallbladder. The patient was doing well with no evidence of recurrence 6 months after surgery.

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A pancreatic endocrine tumor measuring 1.5×1.0×1.0 cm in a 67‐year‐old man with recurrent hypoglycemic attacks was examined by immunohistochemistry and electron microscopy. The tumor cells were relatively uniform, and almost all of them were immunoreactive to Insulin. A few calcitoninpositive cells could be identified scattering in tumor cell strands, and the content of calcitonin in the tumor was 85 ng/g wet tissue. Coexistence of insulin and calcitonin in tumor cells was demonstrated by using adjacent semithin sections of the Epon‐embedded material. Electron microscopically, the tumor consisted of a single type of cells with secretory granules identical to B‐cell granules in the normal counterpart.

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