Brief Reports J Siveke, M Siebeck, T Mussack, et al. 11. Morishita T, Kamiya T, Munakata Y, Tsuchiya M. Radiologic and endoscopic studies of gastric ulcers associated with Candida infection.Acta Gastroenterol Latinoam 1993;23:223-9. 12. Hochter W, Wagner N, Hemmer E, Kunert H, Ottenjann R. Fungal infestation of gastroduodenal ulcers: incidence and significance Dtsch Med Wochenschr 1982;107:845-8. 13. Lipp RW, Schnedi J, HAmmer HE, Kotanko P, Leb G, Krejs GJ. Evidence of accelerated gastric emptying in longstanding diabetic patients after ingestion of a semisolid meal. J Nucl Med 1997;38:814-8. 14. Chocarro Martinez A, Galindo Tobal F, Ruiz-Irastorza G, Gonzalez Lopez A, Alverez Navia F, Ochoa Sangrador C, Martin Arribas MI. Risk factors for esophageal candidiasis. Eur J Clin Microbiol Infect Dis 200;19:96-100. 15. Neeman A, Avidor I, Kadish U. Candidal infection of benign gastric ulcers in aged patients. Am J Gastroenterol 1981;75: 211-3. 16. Di Febo G, Miglioli M, Calo G, Biasco G, Luzza F, Gizzi G, et al. Candida albicans infection of gastric ulcer frequency and correlation with medical treatment. Results of a multicenter study. Dig Dis Sci 1985;30:178-81. 17. Minoli G, Terruzzi V, Butti GC, Benvenuti C, Rossini T, Rossini A. A prospective study on Candida as a gastric oppor- tunistic germ. Digestion 1982;25:230-5. 18. Ramani R, Ramani A, Kumari GR, Rao SA, Chkravarthy S, Shivananda PG. Fungal colonization in gastric ulcers. Indian J Pathol Microbiol 1994;37:389-93. Figure 1. Retrograde cholangiogram demonstrating long stenosis of distal extrahepatic bile duct. Stenosis of the common bile duct caused by synchronous pancreatic cystadenoma and cholangiocarcinoma Mechanical obstruction of the common bile duct may be caused by benign or malignant tumors. Herein, a rare case is reported of recurrent bile duct stenosis caused by two distinct tumors, mucinous cystadenoma of the pancreas and synchronous distal extrahepatic cholangiocarcinoma. To our knowledge, coexistence of these tumors has not been described. Case report. A 67-year-old woman was referred because of jaundice but not abdominal pain, accompanied by pale stools and dark urine. The patient also complained of nausea, occasional vomiting, and tiredness but denied weight loss, night sweats, and fever. The history included Helicobacter pylori-related duodenal ulcers and hyper- tension. Family history was unremarkable with respect to malignant tumors. Except for jaundice and goiter, exami- nation was unremarkable. Laboratory test results includ- ed the following: alanine aminotransferase, 162 U/L (nor- mal: <19 U/L); aspartate aminotransferase, 264 U/L (<24 U/L); alkaline phosphatase, 383 U/L (60-190 U/L); 7-glu- tamyle transferase, 500 U/L (<28 U/L); and total bilirubin, 7.85 mg/dL (<1.1 mg/dL). Reprint requests: PD Dr. med Christian Folwaczny, Medizinische Poliklinik Innenstadt, Ludwig-Maximilians Universitdt Miinchen, Pettenkoferstr. 8a, D-80336 Miinchen Germany. Copyright 9 2003 by the American Society for Gastrointestinal Endoscopy 0016-5107/2003/$30.00 + 0 doi:lO. 1067~rage.2003.351 r i I ~!crlt: ~ 9 , 0 % i Figure 2. Preoperative CT showing cystic lesion in head of pancreas compressing bile duct with plastic stent. Endoscopic retrograde cholangiography revealed stenosis of the distal bile duct over a length of about 4 cm (Fig. 1) and slight dilatation of the intra- and extrahepat- ic bile ducts. The main pancreatic duct appeared normal. After dilation with bougies, an llF plastic stent was inserted. CT displayed compression of the common bile duct, dilatation of the proximal extra- and intrahepatic bile ducts, and a unilocular cystic tumor in the head of the pancreas adjacent to the bile duct stenosis (Fig. 2). Further preoperative assessment, including cytologic specimens obtained at ERCP, appeared to exclude malig- nant disease, and a decision was made to surgically remove the cystic lesion in the head to decompress the bile VOLUME 58, NO. 2, 2003 GASTROINTESTINAL ENDOSCOPY 311