PMC6532322_01
MRI abdomen with and without contrast: (a) T2 image and (b) MRCP image reveal moderate to severe intrahepatic biliary ductal dilation. The common duct measures 1.5 cm in greatest diameter "red arrow". The pancreatic duct is also dilated measuring up to 0.6 cm at the head "yellow arrow". No intraluminal filling defect. (c) T1 image with contrast reveals mild distal common bile duct wall enhancement "blue arrow".
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fig1
Magnetic resonance image/magnetic resonance cholangiopancreatography (MRI/MRCP) was performed and revealed moderate to severe intrahepatic and extra hepatic biliary ductal dilatation with mild enhancement of the distal common bile duct without choledocholithiasis or discrete mass, and pancreatic duct dilation with normal pancreas [Figure 1].
Endoscopic (ERCP) images reveal a 2cm ampullary mass.
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fig2
An endoscopic retrograde cholangiopancreatography (ERCP) was performed and revealed a large ampullary mass distorting the anatomy, which precluded cannulation of the common bile duct [Figure 2].
Histopathology images H&E [4x (a) and 0x (b)] reveal ampullary neuroendocrine tumor infiltrating the mucosa, submucosa, and muscularis propria with angiolymphatic invasion. Immunohistochemical stain images are positive for somatostatin [4x (c) and 10x (d)], and synaptophysin [2x (e) and 4x (f)].
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Immunohistochemical stains were positive for somatostatin, and negative for gastrin, serotonin and pancreatic polypeptide [Figure 3].