case_images: PMC6532322_01
case_images: MRI abdomen with and without contrast: (a) T2 image and (b) MRCP image reveal moderate to severe intrahepatic biliary ductal dilation. The common duct measures 1.5 cm in greatest diameter "red arrow". The pancreatic duct is also dilated measuring up to 0.6 cm at the head "yellow arrow". No intraluminal filling defect. (c) T1 image with contrast reveals mild distal common bile duct wall enhancement "blue arrow".
case_images: CRIGM2019-9506405.001.jpg
case_images: PMC6532322_01_CRIGM2019-9506405.001.jpg
case_images: fig1
case_images: Magnetic resonance image/magnetic resonance cholangiopancreatography (MRI/MRCP) was performed and revealed moderate to severe intrahepatic and extra hepatic biliary ductal dilatation with mild enhancement of the distal common bile duct without choledocholithiasis or discrete mass, and pancreatic duct dilation with normal pancreas [Figure 1].
case_images: Endoscopic (ERCP) images reveal a 2cm ampullary mass.
case_images: CRIGM2019-9506405.002.jpg
case_images: PMC6532322_01_CRIGM2019-9506405.002.jpg
case_images: fig2
case_images: An endoscopic retrograde cholangiopancreatography (ERCP) was performed and revealed a large ampullary mass distorting the anatomy, which precluded cannulation of the common bile duct [Figure 2].
case_images: Histopathology images H&E [4x (a) and 0x (b)] reveal ampullary neuroendocrine tumor infiltrating the mucosa, submucosa, and muscularis propria with angiolymphatic invasion. Immunohistochemical stain images are positive for somatostatin [4x (c) and 10x (d)], and synaptophysin [2x (e) and 4x (f)].
case_images: CRIGM2019-9506405.003.jpg
case_images: PMC6532322_01_CRIGM2019-9506405.003.jpg
case_images: fig3
case_images: Immunohistochemical stains were positive for somatostatin, and negative for gastrin, serotonin and pancreatic polypeptide [Figure 3].