Pancreatic ductal adenocarcinoma (PDAC, red), ampullary carcinoma (AC, blue), and distal common bile duct carcinoma (DCBDC, green) all arise within close proximity to one another and can therefore overlap in terms of the anatomic space they occupy. Furthermore, PDAC can secondarily involve the ampulla or common bile duct, and AC and DCBDC can similarly invade structures from which they did not originate. Careful consideration of the size, epicenter, presentation, and histology of each lesion should allow for accurate diagnosis.