Case History
The patient was a 66-year-old woman who had been receiving chemotherapy comprising pertuzumab, trastuzumab, and docetaxel for invasive ductal breast cancer with liver and brain metastases, since 2016. She became aware of epigastric discomfort in October 2019; in early December of the same year, she began passing dark-colored urine and visited our hospital. Blood tests revealed elevated hepatobiliary enzymes, while contrast-enhanced computed tomography (CECT) scan of the abdomen showed wall thickening of the middle to distal bile duct and dilated intrahepatic bile ducts. No mass was evident around the bile duct wall (Fig. 1). Obstructive jaundice due to malignant lesion in the bile duct was suspected and the patient was admitted to our hospital for further investigation and treatment.