PMC3895687_01
CT scan at the diagnosis. Contrast CTscan of the abdomen demonstrating an enlargement of the common bile duct (14 mm in diameter, see black arrow) and of the of the gallbladder with an inhomogeneous material into the lumen compatible with biliary sludge and microlithiasis. The extra-hepatic bile ducts swelling was evident until the upper papillary tract.
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F1
Abdominal ultrasonography (US) showed biliary sludge and bile duct dilation, and magnetic resonance imaging (MRI) with cholangiography confirmed an enlargement of extra-hepatic bile ducts (14 mm in diameter) evident until the upper papillary tract, where a stop of the signal suggested a tumor of the duodenal papilla (Figure 1).
Left mammogram. A nodule with irregular margins revealed in the left breast.
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F2
After mammography with FNAC describing a 30 mm breast carcinoma in the left breast (Figure 2), she was admitted at our department of General Surgery and Breast Unit, with a diagnosis of primary breast cancer and primary carcinoma of the duodenal papilla.
Histological features of pancreatic mass. (a) Small disaggregated tumor cells infiltrating the pancreatic parenchyma (H&E staining, x100). (b) Immunohistochemical staining of ER in the pancreatic head mass (x250).
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F3
Pathological examination of the pancreatic mass revealed a lesion of 2.5 cm infiltrating the ampulla and the perivisceral adipose tissue, but surprisingly did not confirm primary adenocarcinoma of the pancreas: microscopic features consisted of a metastatic lobular carcinoma of the breast (Figure 3).
Histological features of breast carcinoma. (a) Breast lobular carcinoma (H&E staining, x250). (b) Immunohistochemical staining of ER in the breast lobular carcinoma (x250).
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F4
Breast specimen confirmed a grade II invasive lobular carcinoma (Figure 4) exhibiting high levels of estrogen (90%) and progesterone receptors (80%), HER2-negative, ki-67 = 20%.