PMC4706259_01
MRCP (A) and ERCP (B) findings showing a dominant stricture of the confluence of the right and left hepatic duct (arrow). MRCP = magnetic resonance cholangiopancreatography, ERCP = endoscopic retrograde cholangiopancreatogtaphy.
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F1
MRI and MRCP confirmed a dominant biliary stricture at the hepatic confluence indicative of a Bismuth-Corlette type IV tumor and mild bilateral dilatation of the intrahepatic ducts (IHDs) (Figure 1A). The patient underwent an ERCP and a spyglass cholangioscopy with brush biopsy where no stones were identified in the biliary tree (Figure 1B).
Smear from brushing cytology obtained during ERCP. Typical eosinophils can be seen without any evidence of malignancy (black arrows). Giemsa stain, magnification x400. ERCP = endoscopic retrograde cholangiopancreatogtaphy.
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F2
In cytopathology of biliary brushing specimens typical eosinophils were noticed, whereas cellular atypia of the biliary epithelium was not observed (Figure 2).
Corresponding image (MRCP) 6 months after initial presentation showing the resolution of the biliary stricture. MRCP = magnetic resonance cholangiopancreatography.
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F3
The patient continued on steroids for another 6 weeks tapered down by 10 mg every week and on follow-up after 6 months her MRCP findings were unremarkable (Figure 3).