18815636 Visualization

A 28 Age - year Age - old Age woman Sex was referred Clinical_event with a 4 Duration - week Duration history of continuous Detailed_description , moderate Severity right Biological_structure upper Biological_structure quadrant Biological_structure pain Sign_symptom associated with jaundice Sign_symptom , as well as weight Sign_symptom loss Sign_symptom ( 10 Lab_value kg Lab_value over 3 Duration months Duration ) and a liver Biological_structure mass Sign_symptom identified by ultrasonography Diagnostic_procedure .
The pain Coreference sensation Coreference seemed different Lab_value from previous colicky Sign_symptom attacks Sign_symptom the patient had experienced before she underwent laparoscopic Detailed_description cholecystectomy Therapeutic_procedure 7 Date years Date previously Date .
On physical Diagnostic_procedure examination Diagnostic_procedure , she was obese Sign_symptom ( body Diagnostic_procedure mass Diagnostic_procedure index Diagnostic_procedure 37.8 Lab_value ), with icterus Sign_symptom noted over the conjunctivae Biological_structure , oral Biological_structure mucosa Biological_structure and skin Biological_structure .
Imaging modalities included computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ), positron Diagnostic_procedure emission Diagnostic_procedure tomography Diagnostic_procedure ( PET Diagnostic_procedure ) and endoscopic Diagnostic_procedure cholangiopancreatography Diagnostic_procedure ( ERCP Diagnostic_procedure ) (Fig.1).
The patient underwent exploratory Detailed_description laparotomy Diagnostic_procedure .
Intraoperative Detailed_description ultrasonography Diagnostic_procedure revealed a cystic Detailed_description lesion Sign_symptom measuring 3.5 Area 2.5 Area cm Area within the central Biological_structure portion Biological_structure of Biological_structure the Biological_structure liver Biological_structure , anterior Biological_structure to Biological_structure the Biological_structure porta Biological_structure hepatis Biological_structure .
Intraoperative Detailed_description cholangiography Diagnostic_procedure demonstrated an extensive Severity stricture Sign_symptom obliterating the left Biological_structure hepatic Biological_structure duct Biological_structure , with partial Severity occlusion Sign_symptom of the right Biological_structure hepatic Biological_structure duct Biological_structure .
An extended Detailed_description left Detailed_description lobectomy Therapeutic_procedure was done en Detailed_description bloc Detailed_description with Detailed_description the Detailed_description biliary Detailed_description confluence Detailed_description .
On frozen Diagnostic_procedure - section Diagnostic_procedure examination Diagnostic_procedure , all margins Diagnostic_procedure of Diagnostic_procedure the Diagnostic_procedure excised Diagnostic_procedure specimen Diagnostic_procedure were free Lab_value of Lab_value malignant Lab_value cells Lab_value .
Reconstruction Therapeutic_procedure was performed with a Roux Detailed_description - en Detailed_description - Y Detailed_description cholangiojejunostomy Therapeutic_procedure to 3 Biological_structure second Biological_structure bile Biological_structure duct Biological_structure radicals Biological_structure in the right Detailed_description side Detailed_description .
Intraoperatively, radiotherapy Therapeutic_procedure was applied to the surgical Biological_structure margins Biological_structure .
After this, the patient underwent 6 Duration weeks Duration of image Detailed_description - guided Detailed_description external Detailed_description beam Detailed_description radiation Therapeutic_procedure centred on the resection Biological_structure field Biological_structure labelled at surgery.
The final pathology described this tumour as an infiltrating Detailed_description , moderately Lab_value differentiated Detailed_description squamous Disease_disorder cell Disease_disorder carcinoma Disease_disorder associated with severe Severity dysplasia Disease_disorder of the bile Biological_structure - duct Biological_structure epithelium Biological_structure (Fig.2).
The patient recovered Sign_symptom without complications Sign_symptom and was doing Sign_symptom well Sign_symptom 18 Date months Date after Date the initial surgical procedure, with an unremarkable Lab_value CT Diagnostic_procedure scan Diagnostic_procedure .