case_images: PMC10314817_01
case_images: Enhanced CT findings. (a) A well-defined tumor from a cystic duct to a distal bile duct was observed (yellow arrow), and a hepatic-sided bile duct seen from the tumor was dilated. (b) Gallbladder mucosa was well-contrasted, and the wall was thickened (yellow arrow). CT: computed tomography.
case_images: CRIS2023-5825045.001.jpg
case_images: PMC10314817_01_CRIS2023-5825045.001.jpg
case_images: fig1
case_images: Enhanced computed tomography (CT) revealed a well-enhanced tumor in the distal bile duct and dilation of the hepatic bile duct (Figure 1(a)). In addition, the gallbladder mucosa was thickened, with a homogeneous contrast effect (Figure 1(b)).
case_images: MRI and MRCP findings. (a) The tumor located in the distal bile duct had a low T2 signal (yellow arrow). (b) MRCP showed a filling defect of the distal bile duct and dilation of the hepatic-sided bile duct seen from the tumor (yellow arrow). MRCP: magnetic resonance cholangiopancreatography; MRI: magnetic resonance imaging.
case_images: CRIS2023-5825045.002.jpg
case_images: PMC10314817_01_CRIS2023-5825045.002.jpg
case_images: fig2
case_images: T2 signal tumor in the common bile duct (Figure 2(a)), and magnetic resonance cholangiopancreatography (MRCP) showed dilation of the hepatic-sided bile duct from the tumor (Figure 2(b)). The thickened gallbladder walls had a homogeneous low T2 signal; however, liver invasion by the tumor was not significant.
case_images: ERCP and IDUS findings. (a) ERCP showed a filling defect of the distal bile duct; the cystic duct was invisible. (b) IDUS showed that the tumor had invaded the bile duct subserosa (yellow arrow). (c) The patient's distal bile duct was almost obstructed by the tumor. ERCP: endoscopic retrograde cholangiopancreatography; IDUS: intraductal ultrasonography.
case_images: CRIS2023-5825045.003.jpg
case_images: PMC10314817_01_CRIS2023-5825045.003.jpg
case_images: fig3
case_images: Endoscopic retrograde cholangiopancreatography (ERCP) revealed a filling defect in the distal bile duct, and the cystic duct was invisible (Figure 3(a)). Moreover, intraductal ultrasonography (IDUS) showed a papillary tumor in the common bile duct and indicated invasion of the bile duct subserosa (Figures 3(b) and 3(c)).
case_images: Macroscopic findings. (a) Macroscopic findings revealed a papillary tumor that had invaded the common bile duct. The distal bile duct lumen was severely constricted by the tumor invasion (yellow arrow). (b) Cross section of the resected specimen revealed that the white tumor extensively invaded the liver (white arrow), cystic duct (red arrow), common bile duct (yellow arrow), and pancreas (pink arrow). Black arrows point to the papilla of Vater.
case_images: CRIS2023-5825045.004.jpg
case_images: PMC10314817_01_CRIS2023-5825045.004.jpg
case_images: fig4
case_images: A macroscopic examination of the resected specimen revealed a papillary tumor that had extensively invaded the liver, cystic duct, bile duct, and pancreas (Figures 4(a) and 4(b)).
case_images: Histopathological images showed that the tumor was papillotubulary and had broad-based growth of columnar cells with mucus production in the gallbladder; hematoxylin and eosin staining: (a) 20x and (b) 100x. Immunohistochemical analysis showed the tumor cells were positive for mucin (MUC)5AC staining (c), but negative for MUC2 (d) and p53 (e) (all 100x).
case_images: CRIS2023-5825045.005.jpg
case_images: PMC10314817_01_CRIS2023-5825045.005.jpg
case_images: fig5
case_images: Permanent histopathological findings indicated that the tumor was papillotubulary and had broad-based growth of columnar cells with mucus production in the gallbladder (Figures 5(a) and 5(b)). Immunohistochemical analysis revealed that the tumor cells were positive for mucin (MUC)1, MUC5AC, and MUC6, but negative for MUC2 and p53 (Figures 5(c), 5(d), and 5(e)).