PMC6035910_01
Contrast-enhanced CT showed multiple cystic lesions with septa in the pancreatic head (black arrow) (a, b) and fistulas between the cystic lesions and common bile duct (white arrow) (c). PET-CT showed increased FDG accumulation (SUVmax: 4.1) in the multiple cystic lesions in the pancreatic head (black arrowhead) (d).
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Contrast-enhanced computed tomography (CT) demonstrated multiple cystic lesions with septa in the pancreatic head and fistulas between the cystic lesions and common bile duct (Fig. 1a-c). Positron emission tomography (PET)-CT showed increased fludeoxyglucose (FDG) accumulation (SUVmax: 4.1) in the multiple cystic lesions in the pancreatic head (Fig. 1d).
ERCP showed dilated duodenal papilla with mucin extrusion (a), a pancreatobiliary fistula (thin white arrow) between the cystic lesion (thick black arrow) and common bile duct (white arrow) (b), the dilated common bile duct containing mucinous material (thick white arrow) (c), and segmental dilation of the main pancreatic duct of 7 mm in diameter (thick white arrow) and a pancreatic cyst of 6 mm in diameter that communicated with the main pancreatic duct (thick black arrow) (d).
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ERCP and intraductal ultrasonography (IDUS) showed a pancreatobiliary fistula and dilated common bile duct containing mucinous material (Fig. 2).
The resected specimen showed fistulas between the cystic lesions and common bile duct. Common bile duct: thick white arrow; fistulas: thick black arrow; and duodenal papilla: black arrowhead.
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The resected specimen showed fistulas between the cystic lesion and common bile duct (Fig. 3).
Histopathological examination showed the pancreatobiliary fistula (Common bile duct: thick white arrow; fistula: black arrowhead) (a). The epithelia of the pancreatic ducts revealed papillary proliferation arising from an intraductal neoplasm (b). Immunohistochemistry examination showed CDX2- and MUC2-positive reactions (c, d).
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Histopathological examination showed the pancreatobiliary fistula and found that the main and branch pancreatic ducts of the pancreatic head were dilated and filled with mucus (Fig. 4a). The epithelia of the pancreatic ducts revealed papillary proliferation arising from an intraductal neoplasm (Fig. 4b). Immunohistochemistry examination showed CDX2- and MUC2-positive reactions (Fig. 4c,d).