PMC4722045_01
Abdominal ultrasonography showed two tumors extending into the common bile duct. Doppler ultrasound showed a blood flow signal within the tumor
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Fig1
Abdominal ultrasonography revealed a cystic dilatation of the extrahepatic bile duct and two protruding tumors in the lumen of the dilated common bile duct (Fig. 1).
Abdominal CT showed two enhanced tumors (diameter, 4 cm) in the inferior and middle bile duct. Yellow arrows indicate the tumor locations
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Fig2
Abdominal computed tomography (Fig. 2) demonstrated a cyst within the common bile duct measuring 7 cm in diameter and two enhanced tumors measuring 4 cm in diameter located in the inferior bile duct and middle bile duct.
Magnetic resonance cholangiopancreatography demonstrated a cystic dilatation of the extrahepatic bile duct (Todani's CBD classification: type 4-A)
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Fig3
Magnetic resonance cholangiopancreatography (Fig. 3) clearly demonstrated a cystic dilatation of the extrahepatic bile duct (Todani's CBD classification: type 4-A).
Endoscopic retrograde cholangiopancreatography showed two tumors, and biopsy of one of the tumors confirmed adenocarcinoma
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Fig4
Endoscopic retrograde cholangiopancreatography (Fig. 4) also demonstrated a cystic dilatation of the bile duct as well as the presence of two tumors.
The resected specimen demonstrated tumors in the inferior and middle bile ducts. Arrow indicates the papilla of Vater
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Fig5
The resected specimen demonstrated tumors in the inferior and middle bile ducts (Fig. 5).
a, b Pathological examination revealed a well-differentiated tubular adenocarcinoma in the inferior bile duct (a) (hematoxylin and eosin (H.E., x120) and middle bile duct (b) (H.E., x120)
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Fig6
A postoperative histopathologic examination revealed a well-differentiated tubular adenocarcinoma, which entirely remained within the mucosal layer, and no lymph node metastasis was found (Fig. 6).