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case_images: Enhanced computed tomography demonstrated (A) a small high-density mass in the distal common bile duct and dilated common bile duct and (B) a peritoneal nodule in the left abdominal cavity (yellow arrow).
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case_images: IU/L, ALT (alanine aminotransferase) 569 IU/L, ALP (alkaline phosphatase) 1236 IU/L, GGTP (gamma-glutamyl transpeptidase) 1632 IU/L, and total bilirubin 1.4 mg/dL. In addition, abdominal ultrasound revealed a dilated intra-extrahepatic bile duct, whereas contrast-enhanced CT showed a small mass in the distal bile duct (Figure 1A) and a peritoneal nodule in the left abdominal cavity (Figure 1B).
case_images: Endoscopic retrograde cholangiography revealed filling defect in the distal common bile duct.
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case_images: Endoscopic ultrasound revealed a 13-mm mass in the duodenal major papilla, and endoscopic retrograde cholangiography (ERC) showed a filling defect in the distal bile duct (Figure 2).
case_images: Histologic finding of (A) the tumor in the ampulla of Vater (x400) and (B) primary ovarian cancer (x200). Psammoma body was found in the both findings. Histologic findings of the tumor in the ampulla of Vater closely resemble ovarian cancer resected 11 years ago in hematoxylin-eosin staining.
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case_images: Pathologically, the tumor was an adenocarcinoma with papillary growth and psammoma bodies that closely resembled the histology of the ovarian cancer removed 11 years ago (Figure 3A and B).
case_images: Immunohistochemical stains of (A) Wilms tumor 1, (B) cancer antigen-125, and (C) estrogen receptor were positive, (D) progesterone receptor were weak positive.
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case_images: The tumor showed weak positivity for progesterone receptor antibodies, and these results were compatible with papillary/peritoneal metastasis of the ovarian cancer (Figure 4).