case_images: PMC9848047_01
case_images: CT with oral contrast revealing a soft tissue ampullary lesion on axial and coronal images.
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case_images: AKI. Additionally, the periportal, intraabdominal and epicardial lymph nodes were mildly prominent (Fig. 1).
case_images: (A) and (B) malignant appearing soft tissue infiltrative mass within the ampulla of Vater seen on ERCP; (C) cholangiopancreatography showing stenosed distal third of the common bile duct along with a patent pancreatic duct.
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case_images: A tapered tip cannula was inserted through the ampulla and contrast was injected, revealing a patent PD and a single 18-mm long stenosis of the distal third of the CBD with significant dilatation of the proximal CBD and intrahepatic ducts (Fig. 2).
case_images: (A) and (B) endoscopic images showing a single plastic stent inserted into the distal CBD, protruding into the second part of the duodenum; (C) position confirmed on cholangiopancreatography revealing resolution of distal CBD filling defect.
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case_images: Cholangiopancreatography revealed the stent was in good position with good flow of contrast into the duodenum beyond the filling defect (Fig. 3).
case_images: (A) H&E x400 slide showing pigmented melanoma cells with surrounding normal tissue; (B) H&E x40 slide with normal ampulla tissue on far left and tumour in centre; (C) MelanA x200 stain with melanoma; and adjacent normal ampullary tissue on the left; cytoplasmic expression of MelanA/MART1 highlights how the melanocytes are obscured by a dense lymphocytic infiltrate than in the conventional H&E slide; (D) Sox10 stain x200 similarly showing discoloration by malignant melanoma cells with surrounding normal ampullary tissue.
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case_images: Histopathology of the ampullary lesions collected at ERCP showed evidence of malignant large cell tumour with diffuse and focally nested proliferation of epithelioid-shaped cells positive for Melan-A and Sox10 on immunohistochemistry, which was consistent with malignant melanoma (Fig. 4).