Case 55.  Enterococcal ascending cholangitis (80 y-o F)
    Surgical specimen of cholangiocellular carcinoma with secondary necrotizing inflammation of the bile duct    
Key words :  Enterococcus faecalis, ascending cholangitis
Luminal obstruction by invasive bile duct carcinoma often provokes secondary bacterial infection (gross findings).   Cancer tissue (poorly differentiated adenocarcinoma) is necrotic, and secondary coccal infection is associated (HE, low power).
Cocci are identified within the necrotic cancer tissue (HE, high power). Culture of the bile was positive for Enterococcus faecalis.