Postcholecystectomy Biliary Tract Traumatic Neuroma Mimicking Cystic Duct Stump Malignancy.

Abstract

Background: Biliary tract traumatic neuroma is a rare benign hyperplasia of nerve tissue that follows some form of trauma. These lesions closely mimic malignancy, and a conclusive diagnosis is difficult to establish.

Case report: We report the case of a 65-year-old female who presented with jaundice with cholestatic features, abdominal pain, and intermittent episodes of fever. She had undergone open cholecystectomy 3 years prior for gallstone disease. Her liver function tests showed direct hyperbilirubinemia with elevated alkaline phosphatase. Serum CA 19-9 was >3,000 U/L. Cross-sectional imaging showed a nodular mass at the hilum causing extrinsic compression of the common hepatic duct with resultant bilobar intrahepatic biliary dilatation. Endoscopic ultrasound showed an eccentric thickening of the common hepatic duct, just below the hilum. Malignant common hepatic duct stricture was provisionally diagnosed, and the patient underwent open extrahepatic biliary excision with Roux-en-Y hepaticojejunostomy. The proximal and distal resection margins were confirmed negative for dysplasia or malignancy on frozen section. Final histopathologic examination showed conglomeration of nerve fascicles and Schwann cells in a fibrotic stroma, features suggestive of a traumatic neuroma.

Conclusion: Traumatic neuroma of the biliary tree is a rare entity and mimics biliary tract malignancy. Preoperative diagnosis of traumatic neuromas is usually difficult, and surgery is indicated in cases of diagnostic uncertainty.