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case_images: a Abdominal contrast-enhanced CT revealed multiple nodular lesions with contrast-enhancing effects on the pancreatic head (arrow). b several small nodular lesions with contrast-enhancing effects were observed in the pancreatic body and tail (arrow). c Contrast-enhanced CT performed before surgery for right renal cell carcinoma (arrow). d Non-enhanced CT performed 6 months after surgery.
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case_images: In addition, several small nodular lesions with contrast-enhancing effects were observed in the pancreatic body and tail (Fig. 1a, b). Contrast-enhanced CT performed before surgery for right renal cell carcinoma and non-contrast-enhanced CT performed 6 months after surgery revealed no pancreatic tumors (Fig. 1c, d).
case_images: MRCP revealed intrapancreatic bile duct stenosis (arrow) and mild dilatation of the distal bile duct. MRCP, magnetic resonance cholangiopancreatography.
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case_images: Magnetic resonance cholangiopancreatography revealed distal bile duct stenosis and dilatation of the upstream bile duct (Fig. 2).
case_images: FDG-PET revealed no accumulation of tumors in the pancreatic head (arrow). FDG-PET, fluorodeoxyglucose positron emission tomography.
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case_images: Fluorodeoxyglucose positron emission tomography (FDG-PET) revealed no accumulation of tumors in the pancreatic head (Fig. 3).
case_images: a Cholangiography revealed a 3 cm stenosis in the distal bile duct (arrow). b Biliary stent was placed.
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case_images: Cholangiography revealed a 3 cm stenosis in the distal bile duct, and a biliary stent (ZEOTUBE  7Fr, 7 cm, Straight type, Zeon Medical, Tokyo, Japan) was placed (Fig. 4a, b).
case_images: a, b EUS revealed a 29 mm-sized, clearly demarcated mass with abundant Doppler blood flow at the head of the pancreas, and FNA was performed.
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case_images: Endoscopic ultrasonography (EUS) revealed a 29 mm-sized, clearly demarcated mass with abundant Doppler blood flow at the head of the pancreas, and fine-needle aspiration (EZSHOT3  FNA needle, 22gauge, Olympus Medical, Tokyo, Japan) was performed (2 times punctures, each 20 strokes, slow pull methods, no rapid-onsite evaluation) (Fig. 5a, b).
case_images: a Histologically, tumor cells with clear cytoplasm proliferated in an alveolar form. b Immunostaining was positive for CD10.
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case_images: In the tissue, tumor cells with clear cytoplasm proliferated in an alveolar form, and immunostaining was positive for CD10 and pax8 and negative for CK7 and CK20, indicating clear cell carcinoma (Fig. 6a, b).
case_images: a Active bleeding from the duodenal papilla was observed. b Cholangiography revealed bile outflow obstruction due to hemobilia. c, d Fully covered metallic stent was placed, and confirming hemostasis.
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case_images: After temporary nasobiliary drainage was placed (Fig. 7a, b), nasobiliary drainage was replaced with a fully covered metallic stent (HANARO STENT  10 mm x 60 mm, laser cut, Boston Scientific Japan, Tokyo, Japan), and the patient was discharged after confirming hemostasis (Fig. 7c, d).
case_images: a Pancreatic head mass had invaded the bile duct wall and was exposed to the bile duct lumen (arrow). b Tumor tissue was observed not only in the pancreatic head but also in the body and tail. c Histologically, tumor cells with clear cytoplasm proliferating in an alveolar form. d Immunostaining was positive for CD10.
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case_images: In the resected specimen, tumor tissue was observed not only in the pancreatic head but also in the body and tail, and the pancreatic head mass had invaded the bile duct wall and was exposed to the bile duct lumen (Fig. 8a, b). The final histological diagnosis revealed clear cell carcinoma (Fig. 8c, d).