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Best Cases from the AFIP Biliary Papillomatosis1 Editor’s Note.—Everyone who has taken the course in radiologic pathology at the Armed Forces Institute of Pathology (AFIP) remembers bringing beautifully illustrated cases for accession to the Institute. In recent years, the staff of the Department of Radiologic Pathology has judged the “best cases” by organ system, and recognition is given to the winners on the last day of the class. With each issue of RadioGraphics, one or more of these cases are published, written by the winning resident. Radiologicpathologic correlation is emphasized, and the causes of the imaging signs of various diseases are illustrated.
Kristel M. Antila, MD • Heikki Mäkisalo, MD • Johanna Arola, MD Kirsti Numminen, MD History
A previously healthy 46-year-old man presented to the liver unit with jaundice. Liver chemistry test results revealed a plasma total bilirubin peak at 244.5 µmol/L and conjugated bilirubin at 128.3 µmol/L. The plasma alanine aminotransferase level was normal at 42 U/L, and the alkaline phosphatase level was 252 U/L, which is 2.4 times the normal level. The international normalized ratio was 1.1. With regard to tumor markers, the CA 19-9 level was 41 U/L (the normal value is