Non Traumatic Neuroma of the Bile Duct: Report of a Case

Abstract

We report a case of a 46‐year‐old man with a stricture of the bile duct which was caused by neuroma. The patient had a history of six months jaundice without a previous history of abdominal surgical operation. MR imaging and MRCP clearly picked up the dilatation of intrahepatic biliary ducts and the level of stenosis, but it was very difficult to differentiate benign neuroma from malignant stenosis of the common bile duct. Results of preoperative CT, MRI and ERCP evaluation and postoperative histological examination were presented.

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

“…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.…”

“…The etiology of these neuromas should be further investigated. Spontaneous mucosal neuromas and involvement of the gallbladder by neurofibromatosis and ganglioneuromatosis have also been reported [24, 37, 38]. None of our patients had a history of neurofibromatosis or MEN2.…”

“…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. It has also been reported that the signal intensity of the nerve tissue was the same as that of soft tissue and the pancreatic head, resulting in difficulty in detecting small traumatic neuromas of the biliary tree, especially if there is not enough fatty tissue around the bile duct [1, 38-40]. Only a few reports have included the CT and MR imaging findings of traumatic neuroma [12, 38].…”

“…It has also been reported that the signal intensity of the nerve tissue was the same as that of soft tissue and the pancreatic head, resulting in difficulty in detecting small traumatic neuromas of the biliary tree, especially if there is not enough fatty tissue around the bile duct [1, 38-40]. Only a few reports have included the CT and MR imaging findings of traumatic neuroma [12, 38]. Combining cholangioscopy and intraductal ultrasound with biopsy, the preoperative diagnosis of tumors of the extrahepatic bile duct can be improved substantially [21].…”

“…Combining cholangioscopy and intraductal ultrasound with biopsy, the preoperative diagnosis of tumors of the extrahepatic bile duct can be improved substantially [21]. MRCP can reveal the level and extent of stenosis of the bile duct, as ERCP [38]. We supported imaging of the extrahepatic biliary tree with ERCP and MRCP preoperatively; however, definitive diagnosis was not described based on imaging alone.…”