case_images: PMC3506902_01
case_images: CT scan showing mass lesion in segment 4 abutting the left branch of portal vein.
case_images: CRIM.SURGERY2012-786432.001.jpg
case_images: PMC3506902_01_CRIM.SURGERY2012-786432.001.jpg
case_images: fig1
case_images: Computerized Tomography (CT) of the abdomen showed a 4.1 x 3.7 cm heterogeneously enhancing mass lesion in segment IV of liver abutting the left branch of portal vein (Figure 1).
case_images: MRCP showing a filling defect in the left hepatic duct.
case_images: CRIM.SURGERY2012-786432.002.jpg
case_images: PMC3506902_01_CRIM.SURGERY2012-786432.002.jpg
case_images: fig2
case_images: A Magnetic Resonance Imaging (MRI) of upper abdomen with Magnetic Resonance CholagioPancreaticography (MRCP) showed a filling defect in the left hepatic duct with lesion in the adjacent part of liver in segment IV, suggestive of a left hepatic duct tumor with infiltration in the liver (Figure 2).
case_images: Intraoperative picture showing tumor arising from the left hepatic duct. CBD hooked in yellow, hepatic artery in red, and portal vein in blue.
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case_images: PMC3506902_01_CRIM.SURGERY2012-786432.003.jpg
case_images: fig3
case_images: Intraopertaively a lesion arising from the left hepatic duct involving the left branch of portal vein and extending upto the portal confluence was found (Figure 3) rendering the tumor unresectable.
case_images: Histopathology showing a typical rosette appearance of neuroendocrine tumor.
case_images: CRIM.SURGERY2012-786432.004.jpg
case_images: PMC3506902_01_CRIM.SURGERY2012-786432.004.jpg
case_images: fig4
case_images: Histopathology showed typical rosette appearance of a neuroendocrine tumor (Figure 4) and immunohistochemistry positive for CD56, Chromogranin and Synaptophysin (Figure 5).
case_images: Immunohistochemistry staining positive for Chromogranin (a) and Synaptophysin (b).
case_images: CRIM.SURGERY2012-786432.005.jpg
case_images: PMC3506902_01_CRIM.SURGERY2012-786432.005.jpg
case_images: fig5
case_images: Histopathology showed typical rosette appearance of a neuroendocrine tumor (Figure 4) and immunohistochemistry positive for CD56, Chromogranin and Synaptophysin (Figure 5).
case_images: Electron microscopy picture showing multiple granules of varying sizes.
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case_images: PMC3506902_01_CRIM.SURGERY2012-786432.006.jpg
case_images: fig6
case_images: Ultrastructural study of the cell with electron microscopy (Figure 6) showed the presence of multiple neurosecretory granules with muscle tissue.
case_images: PET Scan (a) and Octreotride labelled (b) scan showing tumor limited to the hepatobiliary system.
case_images: CRIM.SURGERY2012-786432.007.jpg
case_images: PMC3506902_01_CRIM.SURGERY2012-786432.007.jpg
case_images: fig7
case_images: Follow up MRCP at 1 year showing absence of any filling defect in the left hepatic duct.
case_images: CRIM.SURGERY2012-786432.008.jpg
case_images: PMC3506902_01_CRIM.SURGERY2012-786432.008.jpg
case_images: fig8
case_images: A follow up MRI (Figure 8) upper abdomen with MRCP at 1 year showed the absence of filling defect in the Left hepatic duct that was seen previously which showed tumor regression.