PMC4906136_01
(a) Abdominal CT scan showing an approximately 2.6 x 1.5 cm mass enhanced in an arterial phase. (b) Follow up CECT 1 month after admission, showing rapid enlargement of the tumor, to 3.8 x 2.7 mm.
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Contrast-enhanced computed tomography (CECT) showed an approximately 2.6 x 1.5 cm mass at the duodenal papilla, enhanced in the arterial phase but washed-out in the venous phase (Fig. 1a). Follow-up CECT 1 month later showed enlargement of the tumor, to 3.8 x 2.7 mm (Fig. 1b).
Duodenoscopy results, showing a smooth red protruding mass compressing the orifice of the papilla of Vater.
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Duodenoscopy revealed a smooth red protruding mass compressing the orifice of the papilla of Vater, making endoscopic retrograde cholangiopancreatography difficult (Fig. 2).
(a) Macroscopic findings of the duodenum, showing a fungiform exposed protruding mass, 50 x 40 x 35 mm, located in the periampulla of the duodenum. (b) Microscopically, the tumor was located mainly in the ampullary region, originating from the terminal segment of the common bile duct in the ampullary region. (c) Histologic examination showed that the tumor consisted of sheets of anaplastic round, ovoid or spindle giant cells admixed with multinucleated osteoclast-like giant cells. (d) Carcinoma in situ was observed, continuously spreading from the tumor at the terminal segment of the common bile duct to the common hepatic duct and cystic duct.
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Macroscopic examination of the duodenum showed a protruding mass, measuring 50 x 40 x 35 mm, located in the periampulla of the duodenum (Fig. 3a). Microscopically, the tumor was found to originate from the terminal segment of the common bile duct in the ampullary region (Fig. 3b). CD68 while the later cells were negative for AE1/AE3, EMA and positive for CD68 (Fig. 3c). Carcinoma in situ (BilIN 3) was also observed, spreading from the terminal segment of the common bile duct to the common hepatic duct and the cystic duct. The surgical margin of the common hepatic duct was positive (Fig. 3d).