PMC5554986_01
Abdominal contrast-enhanced CT scan: an enhancing tumor of 10 mm x 8 mm in size was seen in the distal bile duct.
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On abdominopelvic contrast-enhanced CT, an enhancing 10 mm x 8 mm hypervascular tumor was observed in the distal bile duct and the proximal bile duct was markedly dilated (Fig. 1).
MRCP: a filling defect of 10 mm in the maximal diameter was observed in the distal bile duct. The proximal bile duct was markedly dilated. There is no evidence of pancreatobiliary maljunction.
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There was no evidence of pancreatobiliary maljunction (Fig. 2).
ERC: A stenosis of 10 mm in the maximal diameter was observed in the distal bile duct.
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Endoscopic retrograde cholangiography (ERC) also showed a stenosis of 10 mm in the maximal diameter was observed in the distal bile duct (Fig. 3).
A white nodular infiltrating tumor of 10 mm in the maximal diameter was shown in the distal bile duct.
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The operating time was 343 min and blood loss was 533 mlMacroscopic findings (Fig. 4) shows a white nodular infiltrating tumor of 10 mm in the maximal diameter was observed in the distal bile duct.
Histopathological findings: There were solid clustered cells (NEC components) (upper part of the figure) and tubular structured cells (adenocarcinoma components) (lower part of the figure) with transition between the 2 components in abundant fibrous stroma (a). The NEC cells were labeled with antibodies for synaptophysin (b) and chromogranin A (c). Ki-67 labeling index was 30% (d). Original magnificent: a-c, x100, d, x200.
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Histopathological findings (Fig. 5) shows the tumor composed of cells in solid clusters and cells forming tubular structures with abundant fibrous stroma.