Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography in biliary rhabdomyosarcoma

Figure 1 Contrast enhanced abdominal MRI shows a crescent shaped enhancing soft-tissue density within a dilated CBD.

Figure 2 A: ERCP demonstrates filling defects along the dilated CBD and a diffusely dilated intrahepatic and extrahepatic biliary tree; B: Intraductal tumor protruding from the ampulla post-sphincterotomy. A 7-french biliary stent was placed for decompression.

Figure 3 A few rhabdomyosarcoma cells have eosinophilic cytoplasm suggesting skeletal muscle differentiation but most are very undifferentiated in a myxoid stroma (HE, × 400).

Figure 4 Immunostain for myogenin reveals almost 100% positivity in neoplastic cell nuclei. The growth of this tumor beneath biliary epithelium (top) is typical of botryoid rhabdomyosarcoma (× 250).