Figure 1.

A case of bile duct stricture diagnosed as distal cholangiocarcinoma with peroral cholangioscopy (POCS)-guided forceps biopsy. (A) Computed tomography scan revealed an irregular nodule in the distal bile duct; (B) magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiography showed stenosis in the distal bile duct; (C) endoscopic ultrasonography showed an irregular nodule in the distal bile duct; (D) POCS revealed the irregular granular mucosa that existed distal bile duct. POCS-guided forceps biopsy was performed for the biliary stricture in the distal bile duct and for the non-stenotic extrahepatic and intrahepatic bile ducts to identify the longitudinal extension margin of the cholangiocarcinoma; (E) hematoxylin and eosin staining revealed adenocarcinoma in specimens obtained from the biliary stricture; (F) this patient underwent pancreatoduodenectomy; and (G) this patients was diagnosed with distal cholangiocarcinoma histologically (hematoxylin and eosin stain). POCS, peroral cholangiography.