case_images: PMC4929392_01
case_images: Computed tomography scan of the abdomen showing a soft mass contiguously developed from the gallbladder neck to the upper-middle bile duct (arrows).
case_images: crg-0010-0007-g01.jpg
case_images: PMC4929392_01_crg-0010-0007-g01.jpg
case_images: F1
case_images: The boundaries of the mass seemed to be clear (fig. 1).
case_images: Magnetic resonance cholangiopancreatography indicated diffuse dilation of the intrahepatic bile duct and the common hepatic duct. A tumor is seen in the bile duct (arrow).
case_images: crg-0010-0007-g02.jpg
case_images: PMC4929392_01_crg-0010-0007-g02.jpg
case_images: F2
case_images: Magnetic resonance cholangiopancreatography indicated diffuse dilation of the intrahepatic bile duct and the common hepatic duct (fig. 2).
case_images: ERCP directly showed the mass spreading from the cystic duct to the upper-middle bile duct (arrows).
case_images: crg-0010-0007-g03.jpg
case_images: PMC4929392_01_crg-0010-0007-g03.jpg
case_images: F3
case_images: Endoscopic retrograde cholangiopancreatography (ERCP) directly showed the mass spreading from the cystic duct to the upper-middle bile duct with amorphous filling defect, suggesting the presence of mucobilia (fig. 3).
case_images: Intraoperative picture after resection of the extrahepatic bile duct including the intrapancreatic bile duct.
case_images: crg-0010-0007-g04.jpg
case_images: PMC4929392_01_crg-0010-0007-g04.jpg
case_images: F4
case_images: Next, the planned operative procedure was performed (fig. 4).
case_images: Macroscopically, a papillary proliferated tumor is originated from the cystic duct.
case_images: crg-0010-0007-g05.jpg
case_images: PMC4929392_01_crg-0010-0007-g05.jpg
case_images: F5
case_images: Unfortunately we are not able to show the complete original shape of the surgically resected specimen because the tumor was fragile and detached from the cystic duct lumen during the operation; however, we confirmed that the papillary tumor was arising from the cystic duct (fig. 5).
case_images: Histologic finding showed well-differentiated adenocarcinoma, which was superficially extending from the cystic duct to the epithelium of the whole extrahepatic bile duct. H&E. x40, x100, x200.
case_images: crg-0010-0007-g06.jpg
case_images: PMC4929392_01_crg-0010-0007-g06.jpg
case_images: F6
case_images: Histologic finding showed well-differentiated adenocarcinoma, which was superficially extending from the cystic duct to the epithelium of the whole extrahepatic bile duct (fig. 6).
case_images: Immunohistochemical examination revealed that MUC1 and CDX2 were positive but MUC2, MUC5AC and MUC6 were negative in the papillary region. MUC5AC and MUC6 were positive but MUC1, MUC2, and CDX2 were negative in the flat region. x200.
case_images: crg-0010-0007-g07.jpg
case_images: PMC4929392_01_crg-0010-0007-g07.jpg
case_images: F7
case_images: MUC1 and CDX2 were positive but MUC2, MUC5AC and MUC6 were negative in the papillary region. Meanwhile, MUC5AC and MUC6 were positive but MUC1, MUC2, and CDX2 were negative in the flat region (fig. 7).