Cholangiocarcinoma after flow diversion surgery for congenital biliary dilatation: A case report and review of literature

Figure 1 3D-reconstruction of magnetic resonance cholangiopancreatography shows an abnormally dilated common bile duct (white star). Both right and left hepatic ducts also show intrahepatic dilatations (white arrows).

Figure 2 Abdominal CT images with contrast. A: Five and a half years after his first operation; B: Six years after his first operation. The images show a gradually growing nodule with contrast over a half a year (yellow arrow).

Figure 3 Double balloon enteroscopy shows the cholangiojejunostomy directly. A: There are four-hole anastomoses: Anterior hole, posterior hole, B2 plus B3 hole, and B4 hole, from right to left. A reddish and hemorrhagic tumor protrudes from the posterior hole; B: The tumor extends inside the posterior branch.

Figure 4 Histological analysis of the tumor. A: Macroscopic findings; B: Hematoxylin and eosin (HE) staining, × 20; C: HE staining, ×400. Histological studies show papillary growth and fibrovascular cores in the macroscopically nodular area (yellow arrow), comprising high-grade atypical epithelial cells. There is no invasive carcinoma associated with the intraductal neoplasm.

Figure 5 The graph shows the relationship between age at diversion surgery and interval time. Data represent means and standard deviation. P < 0.0001, one-way analysis of variance and Bonferroni’s multiple comparison test.