Hepatobiliary and Pancreatic: Traumatic bile duct neuroma

Kim, Ho-Hyun; Koh, Youngil; Js, Seoung; Yh, Hur; Ck, Cho

doi:10.1111/j.1440-1746.2011.06840.x

Cited by 5 publications

(10 citation statements)

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“…Neuromas usually appear in CT as a homogenous mass with heterogeneous contrast enhancement and sometimes show secondary degeneration such as a cystic change, cavity formation, necrosis, or calcification. Dilatation of the biliary ducts is the most typical finding [1, 2, 38, 39], which was also demonstrated in our case. The MRI findings of neuromas show masses with low-signal intensity on the T1-weighted images and inhomogeneous high-signal intensity on the T2-weighted images, as was found in the present case.…”

Section: Discussionsupporting

confidence: 83%

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Diffuse Neuromatosis of Intrahepatic and Extrahepatic Bile Ducts as a Rare Cause of Jaundice

et al. 2020

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Background: Neuroma of the biliary tree is extremely rare with no more than 100 cases reported so far. They mostly present with obstructive jaundice and have been commonly described after surgery or abdominal trauma. Although involvement of the extrahepatic bile duct is far more common, occurrence in the intrahepatic ducts has not so far been reported. Case Report: We describe 3 cases of diffuse biliary tree neuroma affecting 3 females aged 53–68 years. None had a history of neurofibromatosis type1. All presented with progressive obstructive jaundice with no evidence of gallstones. A history of previous surgery was noted in 2 patients. Initial impression on clinical and imaging examination was highly suspicious for bile duct carcinoma in 2 patients. Histology showed diffuse neuromatous proliferation replacing and thickening the bile duct walls. The third patient had concurrent neuroma and recurrent cholangiocarcinoma causing great clinical confusion as initial biopsy showed only benign neuroma, but CA 19-9 was steadily increasing, necessitating a second biopsy which then confirmed recurrent carcinoma. Conclusion: This uncommon cause of long-distance bile duct stenosis and progressive jaundice should be included in the differential diagnosis of bile duct neoplasms, in particular when there is a previous surgical history in this abdominal region.

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Section: Discussionsupporting

confidence: 83%

“…We supported imaging of the extrahepatic biliary tree with ERCP and MRCP preoperatively; however, definitive diagnosis was not described based on imaging alone. However, despite the availability of modern imaging techniques, the preoperative diagnosis of neuroma is difficult, and in most cases the final diagnosis is made at surgery [39] .…”

Section: Discussionmentioning

confidence: 99%

Diffuse Neuromatosis of Intrahepatic and Extrahepatic Bile Ducts as a Rare Cause of Jaundice

et al. 2020

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“…Many patients in case reports listed were thought to have an underlying malignancy,6 with elevated CA19-9 and imaging studies concerning for an infiltrative or neoplastic process. In several case reports, a defined enhancing nodule on CT was described,7 which underscored the concern for malignancy. More recently, a neuroma was diagnosed preoperatively by boring biopsy with cholangioscopy8; this particular patient was asymptomatic and was able to avoid surgery.…”

Section: Discussionmentioning

confidence: 99%

Traumatic bile duct neuroma presenting with acute cholangitis: A case report and review of literature

Lalchandani

Korn

et al. 2019

Ann Hepatobiliary Pancreat Surg

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Traumatic neuroma of the biliary tree has been previously reported as isolated case reports. In literature, these typically present following prior liver transplant or cholecystectomy, wherein the bile ducts have been disrupted in some form. Here we report the case of a 41-year old male who initially presented with acute cholangitis ten years after an open cholecystectomy complicated by a bile leak. Endoscopic retrograde cholangiography revealed a stricture within the mid distal common hepatic duct. The patient temporarily resolved his initial episode with stent placement, and he was eventually taken to the operating room for bile duct resection and hepaticojejunostomy given a persistent stricture and concern for underlying malignancy. Final pathology demonstrated a traumatic bile duct neuroma. This unusual entity should be considered in patients with benign appearing strictures presenting years after surgery, and awareness may aid in preoperative counseling as well.

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“…It is an exuberant but nonneoplastic proliferation of the nerve. Histologically, there are a disorganized proliferation of axons, schwann cells, and perineurial cells haphazardly embedded in a fibro‐collagenous background 2,6 with strong and diffuse immunostaining to S100 protein.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, despite all the modern imaging techniques, the certain preoperative diagnosis of traumatic neuroma is difficult 1,2,5,6 . Indeed, several differential diagnoses such postinflammatory fibrosis, retained stones, postoperative scar stricture, cholangiocarcinomas, metastatic lymph nodes, and neuroendocrine tumors must be excluded 1,2,5 .…”

Section: Discussionmentioning

confidence: 99%