PMC5279078_01
Endoscopic ultrasonography showed an intraluminal mass (A-D), measuring 4.0 x 3.5 cm (C), without abundant blood flow signals (A).
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F1
The endoscopic ultrasonography and abdominal computed tomography scans prior to surgery displayed a mass measuring 4.0 x 3.5 cm located in the distal CBD, which had penetrated from the bile duct to the pancreas, with the presence of marked dilatation of the proximal CBD, gallbladder, and right and left common hepatic and intrahepatic ducts (Figs. 1 and 2).
Abdominal computed tomography scan showed an intraluminal mass. On the axial plane, the mass showed soft tissue density shadow in the plain scan (A) and slight contrast enhancement in the arterial phase (B). In the arterial and portal phases, the lesion was enhanced in the coronal (C and D) and sagittal (E and F) planes.
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F2
The endoscopic ultrasonography and abdominal computed tomography scans prior to surgery displayed a mass measuring 4.0 x 3.5 cm located in the distal CBD, which had penetrated from the bile duct to the pancreas, with the presence of marked dilatation of the proximal CBD, gallbladder, and right and left common hepatic and intrahepatic ducts (Figs. 1 and 2).
Microscopically, the tumor was a differentiated carcinoma containing a component of sarcoma-like differentiation. The tumor cells included spindle-shaped cells, oval cells, and epithelioid cells, among which necrosis and giant cells were observed (A-D: hematoxylin and eosin).
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F3
Microscopically, the tumor was a poorly differentiated carcinoma containing a component of sarcoma-like (spindle and/or giant cell) differentiation (Fig. 3).
Immunohistochemical staining of several types of cytokeratin (A, CK7; B, CK19; C, AE1/AE3) and Vimentin (D).
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F4
On immunohistochemistry, the sample was positive for several cytokeratins (CKs), including CK7 (Fig. 4A), CK19 (Fig. 4B), CK18, and pan-CK (AE1/AE3) (Fig. 4C). Immunohistochemistry also showed Vimentin and CEA staining (Fig. 4D).