PMC4929392_01
Computed tomography scan of the abdomen showing a soft mass contiguously developed from the gallbladder neck to the upper-middle bile duct (arrows).
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F1
The boundaries of the mass seemed to be clear (fig. 1).
Magnetic resonance cholangiopancreatography indicated diffuse dilation of the intrahepatic bile duct and the common hepatic duct. A tumor is seen in the bile duct (arrow).
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F2
Magnetic resonance cholangiopancreatography indicated diffuse dilation of the intrahepatic bile duct and the common hepatic duct (fig. 2).
ERCP directly showed the mass spreading from the cystic duct to the upper-middle bile duct (arrows).
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F3
Endoscopic retrograde cholangiopancreatography (ERCP) directly showed the mass spreading from the cystic duct to the upper-middle bile duct with amorphous filling defect, suggesting the presence of mucobilia (fig. 3).
Intraoperative picture after resection of the extrahepatic bile duct including the intrapancreatic bile duct.
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F4
Next, the planned operative procedure was performed (fig. 4).
Macroscopically, a papillary proliferated tumor is originated from the cystic duct.
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F5
Unfortunately we are not able to show the complete original shape of the surgically resected specimen because the tumor was fragile and detached from the cystic duct lumen during the operation; however, we confirmed that the papillary tumor was arising from the cystic duct (fig. 5).
Histologic finding showed well-differentiated adenocarcinoma, which was superficially extending from the cystic duct to the epithelium of the whole extrahepatic bile duct. H&E. x40, x100, x200.
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F6
Histologic finding showed well-differentiated adenocarcinoma, which was superficially extending from the cystic duct to the epithelium of the whole extrahepatic bile duct (fig. 6).
Immunohistochemical examination revealed that MUC1 and CDX2 were positive but MUC2, MUC5AC and MUC6 were negative in the papillary region. MUC5AC and MUC6 were positive but MUC1, MUC2, and CDX2 were negative in the flat region. x200.
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F7
MUC1 and CDX2 were positive but MUC2, MUC5AC and MUC6 were negative in the papillary region. Meanwhile, MUC5AC and MUC6 were positive but MUC1, MUC2, and CDX2 were negative in the flat region (fig. 7).