Figure 4.

A 64 year old woman with a sessile tumour outside of the bile duct. The patient initially presented with obstructive jaundice and underwent endoscopic retrograde cholangiography. (A) Cholangiography showed a stenosis at the intrapancreatic bile duct (arrow). (B) A frame from intraductal ultrasonography showed the probe in the bile duct within the ultrasonographic field of view. Note the tumour located outside of the bile duct (arrows). The narrow dot at the margin of the frame was 1.0 mm in width. Endoscopic transpapillary bile duct biopsy showed no evidence of malignancy. (C) The histological findings of the resected specimen revealed pancreatic cancer (arrowheads) that had invaded the bile duct (haematoxylin and eosin, ×1).