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Carcinoma of the ampulla of Vater, though a well recognised cause of obstructive jaundice, is an uncommon neoplasm. This relative rarity, along with its variable clinical presentation, often results in delayed diagnosis. However, in spite of this, carcinoma of the ampulla of Vater carries a favourable five year survival in the majority of reported series, especially when compared with pancreatic and other periampullary carcinomas. It is unusual for any patient to develop more than one malignant tumour, although it is certainly documented. We report a consecutive series of 43 patients who underwent surgery for ampullary carcinoma of whom five at some time in life had at least one other malignancy. Four have died, three from other carcinomas and one from cardiac and renal disease. Over a 25 year period (1959-1983) at Glasgow Royal Infirmary 43 patients (27 men and 16 women) have had a histologically proven ampullary carcinoma. The age distribution in decades (Figure 1) shows that the peak incidence is in the seventh decade. Forty one patients were diagnosed during life and two additional patients at post mortem. Five (11%) of these 43 by patients had at least one other tumour. All five patients underwent potentially curative surgery for their ampullary carcinomas. The records of all five were available for review. In order to give some indication of the expected cancer occurrence rate in the group of 43 patients, the sex and agespecific person-years of risk were calculated from the date of diagnosis of the ampullary tumour until death, last follow-up or the development of a subsequent primary tumour. Once calculated, the ageand sex-specific incidence rates for the whole of the West of Scotland (Gillis et al., 1982) were applied to calculate the 'expected' incidence of cancer. The probability of detecting the 'observed' number of tumours was calculated by assuming that this followed a Poisson distribution with mean equal to the 'expected' value calculated as described above (Armitage, 1974). The details of the five patients are summarised in Table I. The histology for all the specimens has been reviewed. Two carcinomas were well differentiated, two moderately well differentiated and one poorly differentiated. One of the patients with a well differentiated tumour was treated by local excision of tumour while the other four had Whipple procedures. Four of the five patients developed two tumours while one patient had four different tissue tumours, this last patient developing his ampullary carcinoma as his second tumour. In the case of the first four patients, two developed a second tumour after the ampullary carcinoma, another patient had bladder tumours before and after and in the fourth case the two tumours were diagnosed at the same laparotomy. Female patients The first female patient, who had a moderately well differentiated ampullary carcinoma, died 44

Patients with ampullary carcinoma are prone to other malignant tumours