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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
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.
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.
What is your diagnosis?
Case A: Traumatic neuroma arising near the bile duct
Case B: Traumatic neuroma (amputation neuroma) of the common hepatic duct
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
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com