LAUSR

A 53-year-old female presented with abdominal pain and increased itching in March 2010. CT scan of the abdomen was done on March 28, 2010, which revealed intraand extrahepatic biliary ductal dilatation with coexistent pancreatic ductal dilatation without a definite pancreatic mass (Fig. 2). ERCP was done 3 days later, which revealed an ampullary mass and a distal CBD stricture. She underwent biliary sphincterotomy with stent placement. Multiple biopsies were obtained which revealed adenocarcinoma with mucinous and signet ring cell features (Fig. 3a).