Multicentric recurrence of intraductal papillary neoplasm of bile duct after spontaneous detachment of primary tumor: A case report

Figure 1 Imaging results upon referral. A: Magnetic resonance cholangiopancreatography showing a filling defect in the common bile duct (CBD); B: Endoscopic ultrasound (EUS) showing a papillary tumor in the CBD; C: EUS showing intraductal papillary mucinous neoplasm with a mural nodule; D: ERC showing a filling defect of contrast agent in the CBD; E: Peroral cholangioscopy showing a papillary tumor in the CBD; F: Tumor spontaneously detached during examination.

Figure 2 Pathological findings. A: Pathological specimen obtained using peroral cholangioscopy (approximately 12 mm diameter); B: Hematoxylin and eosin stains showing intermediate nuclear atypia; C-E: Immunohistochemical analysis of MUC2 (undetectable) (C), MUC5AC (positive) (D), and MUC6 (positive) (E).

Figure 3 Follow-up imaging after diagnosis. A: Six months after magnetic resonance cholangiopancreatography (MRCP) showing a defect of the left intrahepatic duct. B: One year after MRCP showing a defect in the left intrahepatic duct and multiple defects in the extrahepatic duct. C: Endoscopic retrograde cholangiography showing multiple filling defects of contrast agent in the extrahepatic and intrahepatic ducts. Peroral cholangioscopy showing papillary tumors in the intrahepatic and extrahepatic ducts.