PMC4435380_01
ERCP demonstrating dilated common bile duct with distal filling defect. Previous cholecystectomy clips noted.
crj-02-107-g001.jpg
PMC4435380_01_crj-02-107-g001.jpg
F1
CBD at the level of the ampulla, with dilation of the CBD and intrahepatic ducts. Cholangiography demonstrated dilation of the CBD with a distal filling defect (Figure 1), although no stone was retrieved with balloon trawl.
Ampullary biopsy with kappa light chain immunohistochemistry staining revealing infiltration with a congophilic material of apple-green birefringence consistent with amyloid.
crj-02-107-g002.jpg
PMC4435380_01_crj-02-107-g002.jpg
F2
Detailed analysis confirmed AL-type amyloidosis (kappa subtype; Figure 2), with evidence of extensive local amyloid deposits replacing the normal structure.