PMC5464395_01
ERCP showing a long segment stricture of the left hepatic bile duct. Multiple irregular intrahepatic ducts are also visible in the right intrahepatic duct, suggestive of sclerosing cholangitis.
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F1
The left main intrahepatic duct also showed a long segment stricture with upstream dilation, and a stent was placed (Figure 1).
Microscopic image of liver biopsy showing tumor infiltration involving the portal lymphovascular spaces, consistent with high-grade metastatic Mullerian carcinoma. Hemotoxylin and eosin stain was used at 400x magnification.
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Transjugular liver biopsy then revealed high-grade metastatic Mullerian carcinoma involving the portal lymphovascular spaces with cholestasis and features of duct obstruction (Figure 2).
Repeat ERCP 2 months after the initiation of chemotherapy, showing resolution of intrahepatic duct irregularities.
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ERCP for stent removal also showed resolution of bile duct irregularities (Figure 3). Eight months after chemotherapy, the patient is in remission without evidence of recurrent liver abnormalities.