An Unusual Cause of Cholangitis

A 57-year-old man with unremarkable previous medical history presented with acute cholangitis and cholestasis. An abdominal computed tomography showed a dilation of the biliary system with hypodense irregular filling defects in the common bile duct (CBD) and previously unknown liver cirrhosis. The papilla was normal; a subsequent intraductal ultrasonography showed multiple papillary projections in the CBD (Fig. 1). These findings were confirmed by cholangioscopy [1], which identified multiple lesions with “fish-egg” appearance protruding in a dilated CBD filled with whitish mucus (Fig. 2). Biopsies with microforceps on the papillary lesions (Fig. 3) were performed, and histological examination highlighted the presence of papillary proliferation with focal high-grade dysplasia without stromal invasion, thus confirming the final diagnosis of intraductal papillary neoplasm BillN-3 (Fig. 4) [2].