Kosin Med J.  2023 Mar;38(1):66-71. 10.7180/kmj.22.135.

Traumatic neuroma of the right posterior hepatic duct with an anatomic variation masquerading as malignancy: a case report

• Shim JR
• Lee TB
• Choi BH
• Ryu JH
• Lee JH
• Yang K

• KMID: 2540765
• DOI: http://doi.org/10.7180/kmj.22.135

Abstract

Traumatic neuroma (TN), also known as amputation neuroma, is a reactive hyperplasia of nerve fibers and connective tissue arising from Schwann cells after trauma or surgery. TN of the bile duct is usually asymptomatic, but rarely can lead to right upper quadrant pain, biliary obstruction, and acute cholangitis. It is very difficult to discriminate TN from malignancy before surgery, although doing so could avoid an unnecessary radical resection of the lesion. In the course of surgery, TN can be caused by unintentional injury of a nerve fiber near the common bile duct (CBD) and heat damage to an artery, complete ligation of an artery, and excessive manipulation of the CBD. Therefore, to prevent TN after cholecystectomy, surgery should be performed carefully with appropriate consideration of anatomic variations, and a cystic duct should not be resected too close to the CBD. The possibility of TN should be considered if a patient who has undergone CBD resection with hepaticojejunostomy or cholecystectomy long ago experiences symptoms of jaundice, cholangitis, or obliteration of the CBD. In this report, we present a case of TN mimicking cholangiocarcinoma that emerged from a cystic duct stump after cholecystectomy.

Keyword

Amputation neuroma; Case reports; Cholangiocarcinoma; Traumatic neuroma

Figure

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  Fig. 1. An 8-mm polypoid lesion at the right posterior hepatic duct; (arrow) an intraductal papillary neoplasm of the bile duct was suspected. (A) Axial view. (B) Coronal view.

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  Fig. 2. A triangular-shaped polypoid lesion at the right posterior hepatic duct was detected (arrow), suggesting early cholangiocarcinoma.

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  Fig. 3. A focal filling defect with a smooth margin at the right posterior hepatic duct (arrow). (A) Endoscopic retrograde cholangiopancreatography and (B) endoscopic ultrasonography.

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  Fig. 4. An interval increase in the size of the polypoid lesion at the right posterior hepatic duct, with strong contrast enhancement (arrow). (A) Axial view. (B) Coronal view.

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  Fig. 5. The filling defect of the right posterior hepatic duct became more prominent than that in the previous endoscopic retrograde cholangiopancreatography (arrow).

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  Fig. 6. (A) Right posterior sectionectomy of the liver with a negative surgical margin of the right posterior hepatic duct (RPHD). RPHA, right posterior hepatic artery; RPPV; right posterior portal vein. Oval-shaped nodule, consisting of haphazardly arranged spindle cells with no nuclear atypia. Immunohistochemically, the spindle cells positively reacted to S100 protein (B: hematoxylin and eosin stain, ×40, C: ×40).

Reference

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