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8 October 2014 - Case of the Week #329

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Thanks to Dr. Saba Hassan, Dow University of Health Sciences (Pakistan) and Dr. Kristin Olson, UC Davis Medical Center, California (USA), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.


   

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Case of the Week #329
Case A:

Clinical History:
A 48 year old man with a cholecystectomy 3 years previous presented with a 4 month history of obstructive symptoms, including jaundice. There was also swelling in the tissue adjacent to the bile duct, which was sent for histopathological evaluation.

Micro images:


Case B:

Clinical History:
A 59 year old woman had painful nodularity of the common hepatic duct several months after sustaining a complex iatrogenic injury to the site during laparoscopic cholecystectomy.

Micro images:



What is your diagnosis?































Diagnosis:
Case A: Traumatic neuroma arising near the bile duct
Case B: Traumatic neuroma (amputation neuroma) of the common hepatic duct

Discussion:
Both cases showed disorganized and thickened nerve bundles composed of spindle shaped cells, without atypia. Case A also showed a focal foreign body type giant cell reaction adjacent to the disorganized nerve bundles, and a strongly immunoreactive S100 stain:

Case A: S100



Traumatic (amputation) neuroma is a tumor-like hyperplasia that usually occurs post-operatively at the stump of the cystic duct. It rarely arises within the gallbladder (Arch Pathol Lab Med 1985;109:574), or without surgery (Hum Pathol 1985;16:1168, Acta Med Okayama 1996;50:273). It may cause postcholecystectomy pain or obstructive jaundice (Hepatogastroenterology 1989;36:255), and may clinically mimic cancer of the common bile duct (Korean J Gastroenterol 2008;52:32).

Histology typically shows hyperplastic nerve bundles, positive for S100.


Nat Pernick, M.D., President
and Shivani Thakore, Associate Medical Editor
PathologyOutlines.com, Inc.
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Bingham Farms, Michigan (USA) 48025
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