PMC4806668_01
A 58-year-old female with type VI biliary cyst and associated cholangiocarcinoma. (a, b) Axial and coronal MRCP images show fusiformly dilated cystic duct (CD) with a wide opening to the common bile duct (CBD) which is also fusiformly dilated. Intrahepatic bile ducts are slightly dilated in the centre. There is a hypointense, heterogeneous mass filling distal parts of both the cystic and choledochal ducts (GB: gallbladder).
CRIRA2015-625715.001.jpg
PMC4806668_01_CRIRA2015-625715.001.jpg
fig1
Intrahepatic bile ducts were minimally dilated in the central part but were in normal caliber in the remainder (Figure 1).
CT examination performed with the suspicion of perforation following ERCP. (a) Axial contrast enhanced CT image shows intraperitoneal free air (short arrow) and periduodenal contrast extravasation (long arrow) suggesting perforation. (b) Multiplanar reconstructed CT image shows fusiform cystic dilatation of the cystic duct having a wide opening to the extrahepatic bile duct which is also fusiformly dilated and the enhancing mass.
CRIRA2015-625715.002.jpg
PMC4806668_01_CRIRA2015-625715.002.jpg
fig2
After the procedure, the patient complained of severe abdominal pain and underwent computed tomography (CT) which showed free intra-abdominal air and periduodenal contrast leakage (Figure 2(a)) consistent with perforation along with the other findings (Figure 2(b)).
Atypical epithelial cells lining a fibrovascular core extending from the cyst wall that is lined by columnar epithelium are seen on the histopathological specimen.
CRIRA2015-625715.003.jpg
PMC4806668_01_CRIRA2015-625715.003.jpg
fig3
On histopathological examination, there was a polypoid mass which was characterized by atypical epithelial cells lining a fibrovascular core extending from the cyst wall that was lined by columnar epithelium (Figure 3).