Simultaneous Extensive Intraductal Papillary Neoplasm of the Bile Duct and Pancreas: A Very Rare Entity

Figure 3

The surgical specimen and a schematic illustration of histopathology grading. (a) The surgical specimen of combined left trisectionectomy, pancreaticoduodenectomy, and total pancreatectomy. The picture shows the opening along extrahepatic bile duct and cut surfaces of liver and pancreas that reveals numerous diffuse soft pink papillary growths occupying the whole extrahepatic bile duct (LHD, RHD, CHD, and CBD) and left intrahepatic segment ducts (B2–B4). The pancreatic head was accidently displaced; therefore, its pancreatic duct (PD) has been labeled by the use of arrow heads. The main PD was diffuse dilation with intraductal lesions prominent at the proximal part, and generalized atrophy of the pancreas parenchyma was noted. No lesion was seen in the gallbladder. (b) A schematic illustration of the surgical specimen histopathological grading showing areas with low-grade (white-dotted area), high-grade (shaded area), carcinoma in situ (black dot), and invasive carcinoma areas located beneath the schema (asterisk). Amp: ampulla of Vater, B2: bile duct of segment 2, B3: bile duct of segment 3, B4: bile duct of segment 4, CBD: common bile duct, CHD: common hepatic duct, LHD: left hepatic duct, PD: pancreatic duct, RHD: right hepatic duct, and S1: segment 1 of liver.

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