case_images: PMC10948169_01
case_images: Preoperative contrast-enhanced computed tomography and endoscopic findings. a Axial section of computed tomography. The tumor is seen as a lower density lesion during the portal phase (surrounded by arrowheads). b Coronal section of computed tomography. Both intrahepatic and extrahepatic ducts are dilated because of obstruction caused by the tumor of the AmV (arrow). c Endoscopic image. The AmV shows inflammation.
case_images: crg-2024-0018-0001-537900_F01.jpg
case_images: PMC10948169_01_crg-2024-0018-0001-537900_F01.jpg
case_images: F1
case_images: Contrast-enhanced computed tomography revealed a tumor measuring 1.6 cm in diameter located at the AmV and distal bile duct (Fig. 1a). Dilatation of the intrahepatic and common bile ducts was also visualized (Fig. 1b). Endoscopic retrograde cholangiopancreatography revealed a tumor in the AmV (Fig. 1c).
case_images: Surgically resected specimen. a The specimen of PD. b The cross-section of the pancreatic head. The tumor at the ampullar of Vater is seen as a white nodule (surrounded by arrowheads).
case_images: crg-2024-0018-0001-537900_F02.jpg
case_images: PMC10948169_01_crg-2024-0018-0001-537900_F02.jpg
case_images: F2
case_images: The tumor was white in color, measured 25 x 22 x 22 mm, and infiltrated through the duodenal mucosa to the muscularis propria, pancreas, and common bile duct (Fig. 2a, b).
case_images: Histopathological examination findings using hematoxylin and eosin staining. a The low magnification rate image of the AmV. The adenocarcinoma is dominant proximal to the AmV. A combination of adenocarcinoma and squamous cell carcinoma be observed in some regions. b A combination of adenocarcinoma and squamous cell carcinoma (magnification: x40). c A combination of adenocarcinoma and squamous cell carcinoma (magnification: x400). The adenocarcinoma is a moderately differentiated tubular adenocarcinoma. d Dominant region of squamous cell carcinoma components (magnification: x400).
case_images: crg-2024-0018-0001-537900_F03.jpg
case_images: PMC10948169_01_crg-2024-0018-0001-537900_F03.jpg
case_images: F3
case_images: Histopathological examination of the resected specimen revealed a combination of moderately differentiated tubular adenocarcinoma and squamous carcinoma with pavement-like arrangements (Fig. 3a-d).