PMC2976516_01
Endoscopic retrograde cholangiopancreatography (ERCP) showing focal stricture of the common hepatic duct at the level of entry in to the cystic duct.
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fig1
These findings were confirmed by a computed tomography (CT) scan of the abdomen and pelvis and a magnetic resonance cholangiopancreatography (MRCP) which further demonstrated a focal stricture of the CHD at the level of the cystic duct entry (Figure 1).
(a) Low power magnification displaying a common bile duct wall with bile duct mucosal glands, composed of columnar cells with basally oriented nuclei and subepithelial collagen. There is no epithelial atypia. The subepithelial area shows periductal fibrosis and pronounced diffuse inflammatory cellular infiltrate. White circle indicates infiltrate. (Hematoxylin and Eosin stain; (b) displaying 20x; (c) displaying 40x magnification). (b) and (c) Higher-power view demonstrating bile duct mucosal glands composed of columnar cells with basally oriented nuclei. In the subepithelial region, there is a dense infiltrate comprising predominantly of eosinophils, identified by their pathognomonic cytoplasmic granules and bilobed nuclei. The eosinophils are present diffusely within the stroma and around the glands. However, in some areas, these cells form clusters of four to five cells. The white arrows demonstrate the clusters of eosinophils. Along with the eosinophils, other inflammatory cells are also identified, including lymphocytes with scanty cytoplasm and small hyperchromatic dark blue nuclei as well as the larger neutrophils with their granular cytoplasm and multilobed nuclei. (Hematoxylin and Eosin stain; 1b displaying 20x; 1c displaying 40x magnification).
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fig2
Histopathology revealed thickening of the CBD wall with periductal fibrosis and a pronounced inflammatory cellular infiltrate comprised almost entirely of eosinophils (Figures 2(a), 2(b), and 2(c)).