PMC3680842_01
CECT showing eccentric thickening of gall bladder wall
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F1
On contrast-enhanced computed tomography (CECT) abdomen, there was a mass lesion in gall bladder (GB) fundus and lower end of the common bile duct (CBD), with CBD compression at two sites (just below the hilum and the lower end of CBD), and bilobar intrahepatic biliary radical dilatation [Figure 1] with no evidence of local or distant spread.
MRCP showing dilated bile duct with multiple sites of narrowing
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F2
Magnetic resonance chalangiopancreaticography (MRCP) was done for delineation of the biliary anatomy and revealed a patent confluence and narrowing at multiple sites [Figure 2].
Smear shows cluster of malignant cells displaying round to oval hyperchromatic nuclei, condensed chromatin, prominent nucleoli, and moderate amount of cytoplasm (MGG, x40 magnification)
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F3
Fine needle aspiration cytology (FNAC) from the left supraclavicular lymph node was positive for malignant cells [Figure 3].
Side viewing endoscopy showing ampullary growth
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F4
On side viewing endoscopy (SVE), there was a large periampullary growth [Figure 4]; biopsy was taken [Figure 5], choangiogram was done [Figure 6], and a metal stent was placed in the CBD [Figure 7].
Biopsy section lamina infiltration by tumor arranged in glands, tumor cells displaying round to oval hyperchromatic nuclei, condensed chromatin, prominent nucleoli in 'some' and moderate amount of cytoplasm (H and E, x40 magnification)
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F5
On side viewing endoscopy (SVE), there was a large periampullary growth [Figure 4]; biopsy was taken [Figure 5], choangiogram was done [Figure 6], and a metal stent was placed in the CBD [Figure 7].
ERCP showing dilated bile duct with multiple sites of narrowing
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F6
On side viewing endoscopy (SVE), there was a large periampullary growth [Figure 4]; biopsy was taken [Figure 5], choangiogram was done [Figure 6], and a metal stent was placed in the CBD [Figure 7].
Metal stent in the bile duct
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F7
On side viewing endoscopy (SVE), there was a large periampullary growth [Figure 4]; biopsy was taken [Figure 5], choangiogram was done [Figure 6], and a metal stent was placed in the CBD [Figure 7].