case_images: PMC1785380_01
case_images: Cholangiographies: A and B). Endoscopic retrograde cholangiopancreatography (ERCP) and C). Magnetic resonance cholangiopancreatography (MRCP) showing a nodular mass protruding into the bile duct lumen from the left wall at the distal end of the common bile duct.
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case_images: F1
case_images: Endoscopic retrograde cholangiopancreatography (ERCP) and MRCP showed a nodular mass with an irregular surface protruding into the bile duct lumen from the left wall at the distal end of the common bile duct (Fig. 1A&1B ).
case_images: PMC1785380_02
case_images: PMC1785380_03
case_images: The surgical specimen showed a golden yellowish polypoid mass (arrow), measuring 1.0 x 1.2 x 0.7 cm in size, projecting from the surface of the intra-pancreatic portion of the bile duct. DU: duodenum, PNC: pancreas head, CBD: common bile duct, GB: gallbladder
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case_images: F2
case_images: The thickening of the bile duct wall at the tumor bed suggested longitudinal and vertical tumor invasion (Figure 2).
case_images: Photomicrographs stained by Hematoxylin and Eosin. A: Tumor cells penetrating the fibromuscular layer of the bile duct, but not reaching to the surrounding pancreatic parenchyma. (Original magnification x200). B: Tumor consisting of fairly uniform polygonal cells in size, with round nuclei and clear and abundant cytoplasm. Neoplastic cells are arranged in combination patterns with solid nests and trabecular growth. Preexisting non-neoplastic gland is entrapped in the lesion. (Original magnification x400)
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case_images: F3
case_images: The tumor cells penetrated the fibromuscular layer of the bile duct, but did not reach the surrounding pancreatic parenchyma (Figure 3).
case_images: Tumor cells were stained by Grimelius silver (A), and positive for immunohistochemical staining of Chromogranin-A (B) and for Synaptophysin (C). Clear cells were completely negative for Keratin, but positive in the intercalated non-neoplastic glands (D).
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case_images: F4
case_images: Immunohistochemical stains were positive for various neuroendocrine markers as chromogranin A, synaptophysin, neuron-specific-enolase, and pancreatic polypeptide (Fig. 4).