PMC5994867_01
Coronal image of contrast-enhanced computed tomography of the abdomen. The common bile duct wall in the junction of cystic duct is thickened (arrows). The common bile duct does not trace until the papilla of Vater, which suggests that there is stenosis in the distal bile duct (arrowheads).
gr1.jpg
PMC5994867_01_gr1.jpg
fig0005
There was no lymph node swelling around the extrahepatic bile duct (Fig. 1).
(a) Magnetic resonance cholangiopancreatography; There are 2 stenotic portions in the common bile duct. One portion is in the junction of the cystic duct (arrows), and the other is in the distal bile duct.The common channel is of normal length. (b) Endoscopic retrograde cholangiopancreatography; There are 2 stenotic portions in the common bile duct. One portion is in the middle bile duct (arrows), and the other is in the distal bile duct (arrowheads).The common channel is of normal length.
gr2.jpg
PMC5994867_01_gr2.jpg
fig0010
One portion was at its junction with the cystic duct and the other was in the distal bile duct (Fig. 2a). Endoscopic retrograde cholangiopancreatography (ERCP) showed similar findings to the MRCP (Fig. 2b).
Macroscopic findings of the extrahepatic duct. There are 2 stenotic portions with rough mucous membrane in the junction of the cystic duct (arrows) and in the distal bile duct (arrowheads).
gr3.jpg
PMC5994867_01_gr3.jpg
fig0015
Macroscopically, there were 2 stenotic regions with rough mucous membrane: in the common bile duct and cystic duct junction and in the distal bile duct (Fig. 3).
(a) Microscopic findings of the tumor in the junction of the cystic duct. The atypical cells form irregular duct structures, and the tumor was diagnosed as a well-to-moderately differentiated adenocarcinoma (hematoxylin and eosin, magnification 20x). (b) Microscopic findings of the tumor in the distal bile duct. The tumor cells spread invasively with solid and trabecular formation. The tumor was diagnosed as a poorly differentiated adenocarcinoma (hematoxylin and eosin, magnification 20x). (c) Microscopic findings of transition zone between the tumor in the junction of the cystic duct and the tumor in the distal bile duct. There was no communication between the 2 cancers (A; the tumor in the junction of the cystic duct, B; the tumor in the distal bile duct) (hematoxylin and eosin, magnification 10x).
gr4.jpg
PMC5994867_01_gr4.jpg
fig0020
The tumor cells had spread to the middle bile duct and invaded the under layer of the serosa (Fig. 4a). On the other hand, the tumor of the distal bile duct was a poorly differentiated adenocarcinoma (Fig. 4b). There was no communication between the 2 cancers (Fig. 4c) and there was no lymph node metastasis.