Preoperative staging of a distal common bile duct tumor by endoscopic ultrasound

A 27-yr-old man with a long-standing history of primary sclerosing cholangitis presented with recurrent episodes of fever and progressive weight loss over 6 mo. The diagnosis of a distal cholangiocarcinoma was made by endoscopic retrograde cholangiography and transpapillary biopsy. The extent of the tumor could be reliably assessed by endoscopic ultrasound, whereas computed tomography scan, angiography, and transabdominal ultrasound failed to visualize the tumor. The intraoperative findings and histologic work-up of the resected specimen confirmed a T3N0M0 adenocarcinoma of the distal common bile duct.