Granular Cell Tumor as an Unusual Cause of Obstruction at the Hepatic Hilum: Report of a Case

Abstract

A diagnosis of malignancy is reasonably assumed when a lesion is found at the hilum or bile ducts in a patient with jaundice who has never undergone biliary surgery. Although benign tumors occasionally develop in this location, preoperative recognition is difficult and most are treated as malignant lesions. We illustrate this clinical scenario in this case report of a granular cell tumor (GCT) that developed at the biliary bifurcation, necessitating right hemi-hepatectomy with extrahepatic biliary tree excision. We describe the clinical presentation, imaging findings, treatment, and histological findings of this tumor. Although rare, a GCT can develop at the hilum and mimic a malignant lesion such as cholangiocarcinoma (CC) radiologically. To our knowledge, this is the fourth report of a GCT at the hilum of the liver. However, the possibility of this tumor should be considered in the differential diagnosis of a lesion in this location.

Ictericia obstructiva secundaria a tumor de células granulares de la vía biliar extrahepática

“…Los gránulos citoplasmáticos corresponden a estructuras similares a lisosomas que contienen mielina o sus productos metabólicos, sugiriendo un origen neural 8 . Atipía y mitosis son raras.…”

Tumors of a Granular Cell Lineage

“…In a review, signs of biliary obstruction were identified in 41 out of 42 reported cases (Lafreniere et al 1991). This stenosis can mimic cholangiocarcinoma, in particular when the tumor occupies a bile duct in the hilar/perihilar region of the liver, where the lesion may resemble Klatskin tumor (Sanchez and Nauta 1991;Te Boekhorst et al 2000;Hoda et al 2005;Lochan et al 2006;Bilanovic et al 2008). The sometimes marked dilatation of the bile duct may be confounded with choledochal cyst.…”