Successful endoscopic procedures for intraductal papillary neoplasm of the bile duct: A case report

Figure 1 Images of cholangioscopic examination, ERC, MRCP and abdominal CT. A: Cholangioscopic examination performed in 1999. A multilobulated papillary tumor was seen protruding into the common bile duct; B: ERC performed in 1999; C: ERC performed in 2008. The extrahepatic bile duct became more dilated in 2008 than in 1999. A polypoid filling defect (arrow heads) could be detected in the distal bile duct; D: MRCP in 1999; E: MRCP in 2004. Cystic lesions connected to the intrahepatic bile ducts of the left liver became enlarged in 2004; F and G: Abdominal CT in 1999; H and I: Abdominal CT in 2004. Intra- and extrahepatic bile ducts became dilated in 2004. A mass in the distal bile duct (arrow heads) and a cystic lesion in the left liver were enlarged in 2004, compared with those in 1999.

Figure 2 Images of ultrasonographic studies. A: EUS showed a mixed echoic mass in the distal bile duct (arrow heads); B: Papillary structure of the mass could be apparently observed on CEH-EUS with Sonazoid^®; C: IDUS showed a 10-mm papillary mass (arrows) in the middle bile duct; D: In the distal bile duct, multilobular and papillary lesions (arrows) were observed. L: Lumen of the bile duct.

Figure 3 EST was performed. A: A soft, bead-like mass was extracted through the orifice of the ampulla of Vater after EST; B: Image of the ampulla of Vater after extraction of the mass by balloon sweep and a net-type catheter.

Figure 4 Histopathological findings. A: Hematoxylin-eosin staining; B: Immunohistochemical analysis for MUC1; C: Immunohistochemical analysis for MUC5AC.