case_images: PMC8067891_01
case_images: T2-weighted abdominal magnetic resonance images in axial (a) and coronal planes (b and c) show intrahepatic biliary duct ectasia of the left liver lobe accompanied with an area of filling defect within dilated biliary ducts with branching distribution. Magnetic resonance cholangiopancreatography image (d) also shows similar findings
case_images: JRMS-25-114-g001.jpg
case_images: PMC8067891_01_JRMS-25-114-g001.jpg
case_images: F1
case_images: In June 2011, magnetic resonance cholangiopancreatography (MRCP) was done [Figure 1] that showed intrahepatic biliary duct ectasia of the left liver lobe accompanied with an area of filling defect within dilated biliary ducts with branching distribution mostly due to neoplastic lesion or mucin.
case_images: Contrast enhanced abdominal computed tomography scan in axial planes revealing left liver lobe biliary ectasia with an infiltrative soft tissue density within intrahepatic biliary ducts showing hypodensity in arterial phase (a) and also in portal (b) and delay phase (c) in comparison to liver parenchyma, note delay enhancement of lesion in comparison to early phase
case_images: JRMS-25-114-g002.jpg
case_images: PMC8067891_01_JRMS-25-114-g002.jpg
case_images: F2
case_images: CT scan was done [Figure 2]. CT scan revealed left liver lobe biliary ectasia with an infiltrative soft-tissue density within intrahepatic biliary ducts suggestive for cholangiocarcinoma versus pyogenic recurrent cholangitis.
case_images: T2-weighted abdominal magnetic resonance images in axial (a-d), coronal (e) and sagittal (f and g) planes demonstrate a T2 high signal intensity lesion in the left liver lobe accompanied with intrahepatic biliary duct ectasia and parenchymal shrinkage without signal change on fat saturation sequences (d-g) Magnetic resonance cholangiopancreatography image (h) shows similar findings as intrahepatic biliary duct ectasia of left liver lobe accompanied with an area of filling defect within dilated biliary ducts showing branching distribution
case_images: JRMS-25-114-g003.jpg
case_images: PMC8067891_01_JRMS-25-114-g003.jpg
case_images: F3
case_images: MRCP was ordered for more evaluation. MRCP demonstrates a T2 high signal intensity lesion in the left liver lobe accompanied with intrahepatic biliary duct ectasia and parenchymal shrinkage [Figure 3].
case_images: Contrast-enhanced abdominal computed tomography scan in axial planes demonstrates branching heterogeneous mass in the left liver lobe accompanied with perilesional staining and focal peripheral biliary ectasia, the mass is hypo/isodense in arterial phase (a and b) and hypodense in portal (c and d) and delay phase (e) in comparison to normal liver parenchyma. Note delay enhancement of lesion in comparison to early phase
case_images: JRMS-25-114-g004.jpg
case_images: PMC8067891_01_JRMS-25-114-g004.jpg
case_images: F4
case_images: Another contrast enhanced abdominal CT scan was ordered in May, 2019 before surgery [Figure 4] which demonstrates heterogeneous mass in size of 70 mm x 42 mm at left liver lobe accompanied with perilesional staining and focal peripheral biliary duct ectasia.
case_images: Neoplastic proliferation of epithelial cells were seen as glandular and cribriform pattern. Cells had medium N/C ratio and hyperchromatic and hyperchrome nuclei. Findings were consistent with mucin secreting neoplasm
case_images: JRMS-25-114-g005.jpg
case_images: PMC8067891_01_JRMS-25-114-g005.jpg
case_images: F5