Figure legends
Figure. 1
CECT scan of the abdomen showed thickening of the walls of the middle to distal bile ducts (arrow) and dilated intrahepatic bile ducts. No mass was evident around the bile duct wall.
CECT, contrast-enhanced computed tomography
Figure. 2
MRI showed a mass-like lesion around the head of the pancreas that was hyperintense on diffusion-weighted imaging(arrow).
MRI, magnetic resonance imaging
Figure. 3
ERCP showed severe stenosis in a relatively long area of the middle to distal bile ducts.
ERCP, endoscopic retrograde cholangiopancreatography
Figure. 4
Intraductal ultrasonography showed a homogeneous circumferential thickening (iso-to hyperechoic) of the bile duct wall at the site of the stenosis was observed.
Figure. 5
Findings on histopathological examination of the biopsy specimen were suggestive of adenocarcinoma(5-1), and immunostaining of the same specimen showed GATA3(5-2), HER2(5-3), and mammaglobin(5-4) positivity.
Figure. 6
A plastic stent in the bile duct was replaced with a SEMS.
SEMS, self-expandable metallic stent
Figure. 7
A plastic stent was placed into the SEMS because tumor invasion was suspected.
SEMS, self-expandable metallic stent
Figure. 8
An additional SEMS was placed in the form of a stent-in-stent because of severe stenosis in the SEMS due to tumor invasion.
SEMS, self-expandable metallic stent