case_images: PMC9259795_01
case_images: Enhanced computed tomography showed dilatation of the intrahepatic bile duct in the left lobe of the liver (A) and common bile duct (B); (C) (MRCP) and (D) (CT three dimensional reconstruction) revealed the dilatation of extrahepatic and intrahepatic bile duct; (E) (coronal view) and (F) (axial view). Irregular dilatation and thickening of the bile duct are visible in the left hepatic lobe; (G) (coronal view) and (H) (axial view) show dilatation of the bile duct in the right left hepatic lobe. (I) Intraoperative cholangioscopy findings: biliary papillomatosis in the left hepatic duct. (J, K) Macroscopic findings: the bile duct is filled with greenish- yellow mucus- like sludge. (L: magnification, x40 and M: magnification, x100; hematoxylin and eosin staining) Microscopic findings: the intrahepatic bile duct, common bile duct and cystic duct were lined by papillary growth neoplasia with high-grade intraepithelial neoplasia. (N) Next-generation sequencing results revealed the mutation of KRAS codon 12 (p.G12F).
case_images: fonc-12-916457-g001.jpg
case_images: PMC9259795_01_fonc-12-916457-g001.jpg
case_images: f1
case_images: Enhanced computed tomography (CT) at our hospital revealed interruption of the intrapancreatic common bile duct ( Figure 1B ) and dilatation of the extrahepatic and intrahepatic bile duct, which was especially obvious in the left lobe of the liver ( Figure 1A ). MRCP showed dilatation of the extrahepatic and intrahepatic bile ducts, irregular dilatation and thickening of the bile duct in the left lobe of the liver ( Figures 1C-H ). On intraoperative cholangioscopy, we found the left hepatic duct filled with mucus and papillary protrusions adhering to the surface of the left hepatic duct ( Figure 1I ). The bile duct was filled with greenish -yellow mucus -like sludge ( Figures 1J, K ). Microscopically, the intrahepatic bile duct, common bile duct and cystic duct were lined by papillary growth neoplasia with high-grade intraepithelial neoplasia ( Figures 1L, M ). G12F) mutation, and the mutation frequency was 62.9% ( Figure 1N ).
case_images: PMC9259795_02
case_images: (A, B) Enhanced computed tomography demonstrated thickening of the distal common bile duct wall, luminal stenosis, dilatation of extrahepatic and intrahepatic bile duct, especially more evident in the right lobe of liver; (C) (MRCP) and (D) (CT three dimensional reconstruction) revealed the dilatation of extrahepatic and intrahepatic bile duct; (E) (diffusion-weighted image) The bile duct showed high intensity; (F) (coronal view) showed the dilatation of intrahepatic bile duct in the right lobe of liver; Intraoperative cholangioscopy revealed the common bile duct wall was full of the white flocculus (G) and rough (H); Grossly, the lumen of intrahepatic bile duct was full of yellow, gelatinous, sticky mucous masses (I, J); abdominal computed tomography (CT) showed homogeneous liver parenchyma without bile duct dilation (K); Microscopically, Intraductal papillary neoplasm of the bile duct(IPNB)with low-grade intraepithelial neoplasia, focal high-grade intraepithelial neoplasia; A large amount of lymphocytes aggregated portal area with extensive bile duct proliferation (L: magnification, x40 and M: magnification, x100; hematoxylin and eosin staining).
case_images: fonc-12-916457-g002.jpg
case_images: PMC9259795_02_fonc-12-916457-g002.jpg
case_images: f2
case_images: Dynamic upper abdominal computed tomography (CT) showed thickening of the distal common bile duct wall, luminal stenosis and dilatation of extrahepatic and intrahepatic bile duct, which was especially pronounced in the right lobe of the liver with a diameter of approximately 15 mm at its widest point ( Figures 2A, B ). Magnetic resonance cholangiopancreatography (MRCP) revealed that the common hepatic duct and intrahepatic bile duct were dilated ( Figures 2C, D, F ). The bile duct wall showed high intensity on diffusion-weighted imaging ( Figures 2E ). The common bile duct wall was rough and full of white flocculus ( Figures 2G, H ). The diameter of the largest one was 18 mm. ( Figures 2I, J ) Pathologic findings were as follows: Intraductal papillary neoplasm of the bile duct (IPNB) with low-grade intraepithelial neoplasia, focal high-grade intraepithelial neoplasia; a large number of lymphocytes aggregated in the portal area with extensive bile duct proliferation ( Figures 2L, M ). The patient was followed up for 6 months after the operation, and there were no signs of recurrence. ( Figure 2K ).