Traumatic biliary neuroma after orthotopic liver transplantation: a possible cause of “unexplained” anastomotic biliary stricture

Navez, Julie; Golse, Nicolas; Bancel, Brigitte; Rode, Agnès; Ducerf, C.; Mezoughi, Salim; Mohkam, Kayvan; Mabrut, Jean‐Yves

doi:10.1111/ctr.12802

Cited by 15 publications

(21 citation statements)

References 14 publications

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“…Of a cohort of 1030 consecutive patients who underwent OLT, the incidence of symptomatic TBN was 0.5%, representing 9.6% of the anastomotic biliary strictures observed. 5 Another study revealed 26 cases of hilar TBN in 93 hepatectomy specimens (27.9%) obtained between 3 and 26 months after OLT, although only a single patient (1.3%) was symptomatic. The authors found that the incidence of neuroma is higher in specimens resected more than 3 months posttransplant.…”

Section: Discussionmentioning

confidence: 97%

“…Because of the move toward conservative treatment of late biliary strictures, many patients are no longer treated surgically, and a true assessment of the incidence of TBN is impossible. 5 Owing to the possibility of progression to chronic rejection and the lack of specific imaging features for a preoperative diagnosis of TBN, physicians must be mindful of the possibility of TBN when facing an unexplained anastomotic biliary stricture after OLT.…”

Section: Discussionmentioning

confidence: 99%

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Terzi

Kırnap²,

Sercan³

et al. 2017

Exp Clin Transplant

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Traumatic neuromas of the biliary tract have occasionally been reported to cause strictures at the cystic duct stump as a late complication of cholecystectomy with common bile duct exploration. The incidence of symptomatic traumatic biliary neuroma appears to be low after orthotopic liver transplant, as only 25 patients have been described previously in the English-language literature. Traumatic (amputation) neuroma is a reactive proliferation of pericholangial nerve fibers induced by injury, but it is not a true neoplasm. The diagnosis of traumatic neuroma is possible only by histopathologic examination; the diagnostic finding is a mass of hyperplastic nerve bundles. We report a patient with a traumatic neuroma causing an early biliary stricture with intrahepatic extension after an orthotopic liver transplant. The lesion failed to respond to repeated endoscopic stenting and eventually required hepaticojejunostomy. A biopsy of the liver graft, performed in the 13th month after transplant, showed chronic ductopenic rejection.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Untitled

Terzi

Kırnap²,

Sercan³

et al. 2017

Exp Clin Transplant

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“…It is well known that ANs generally arise around the bile duct in the abdominal cavity [ 2 – 4 ]. Previous reports have demonstrated 0.5, 0.28, and 0.23% AN incidences in orthotopic liver transplantation, cholecystectomy, and biliary tract surgery, respectively [ 9 – 11 ]. Because delicate nets of nerve fibers surround the common bile duct, symptoms such as abdominal pain, pyrexia, vomiting, and jaundice commonly occur [ 5 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Amputation neuroma mimicking lymph node metastasis of remnant gastric cancer: a case report

et al. 2017

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BackgroundAmputation neuromas (ANs) are reactive hyperplasia of nerve tissues that occur after a trauma or surgery involving the peripheral nerves. Only two previous reports of ANs occurring around the stomach and post gastrectomy have been reported. We report the case of a patient with AN near the remnant stomach who underwent distal gastrectomy for gastric cancer.Case presentationA 76-year-old man underwent distal gastrectomy, D1+ lymphadenectomy, and Billroth-I reconstruction for early gastric cancer in another hospital at 63 years of age. A regular gastrointestinal endoscopic follow-up examination after gastrectomy revealed an ulcerative lesion on the lesser curvature of the remnant stomach, which was diagnosed as remnant gastric cancer based on the histopathological examination. Then, he was transferred to our hospital. An upper gastrointestinal series and endoscopy revealed an 18-mm Type 0-IIc lesion on the lesser curvature of the remnant stomach with an estimated depth within the mucosa (T1a). An abdominal contrast-enhanced computed tomography (CT) failed to detect the primary lesion; however, a slightly enhanced 13 × 10-mm nodule was detected near the lesser curvature of the remnant stomach. An endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of the nodule showed no cancer cell; thus, endoscopic submucosal dissection (ESD) for the remnant gastric cancer was performed. Histopathological examination revealed noncurative resection due to T1b2 and UL (+). We planned an additional surgical resection. Before the resection, CT was performed, which had a 3-month interval with a previous CT, showing an enlargement of the nodule to 16 × 12 mm. We diagnosed the nodule as a lymph node metastasis and performed resection of the remnant stomach, D2 lymphadenectomy, splenectomy, and Roux-en-Y reconstruction. The nodule was later diagnosed as AN based on the histopathological examination. There was no residual cancer in the resected specimen.ConclusionsWe report AN mimicking lymph node metastasis near the remnant stomach of a patient with remnant gastric cancer. When nodules appear in the previous operative field, the possibility of ANs should be considered, although the incidence may be quite low.

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“…It has also been described in bile ducts following biliary surgery, such as after orthotopic liver transplantation5 and cholecystectomy (both laparoscopic and open) 6 7 12. Clinically, the leading differential diagnosis typically is cholangiocarcinoma, due to the similarity of presentation, namely jaundice and intermittent symptomatic right upper quadrant pain 7.…”

Section: Traumatic Neuromamentioning

confidence: 99%

Neural and neurogenic tumours of the gastroenteropancreaticobiliary tract

2018

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Neural lesions occur uncommonly in the gastroenteropancreaticobiliary tract. However, due to the growing number of screening colonoscopy procedures, polypoid neural lesions of the colon are being recognised increasingly and range from benign tumours to high-grade malignant neoplasms. Morphological variability of neural tumours can be wide, although some entities share pathological features, and, as such, these lesions can be diagnostically challenging. We review the spectrum of pathology of neural tumours in the gastroenteropancreaticobiliary tract, with the goal of providing a practical approach for practising surgical pathologists.

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Traumatic biliary neuroma after orthotopic liver transplantation: a possible cause of “unexplained” anastomotic biliary stricture

Abstract: Traumatic biliary neuromas represent a possible diagnosis for unexplained anastomotic BS after OLT. Surgical excision combined with hepaticojejunostomy is effective, allows histological diagnosis, and prevents from recurrence.

Cited by 15 publications

References 14 publications

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Amputation neuroma mimicking lymph node metastasis of remnant gastric cancer: a case report

Neural and neurogenic tumours of the gastroenteropancreaticobiliary tract

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