Symptomatic Traumatic Neuroma Causing Common Bile Duct Stricture Following Orthotopic Liver Transplantation: A Retrospective Three and a Half Year Review
MJ Shealy, DM Cardona, JL Burchette, TJ Cummings, AD Smith, DN Howell, CD Guy. Duke University Medical Center, Durham, NC
Background: Traumatic neuromas (TN) result from abnormal regeneration of peripheral nerve fibers following trauma. Symptomatic TNs causing common bile duct (CBD) stricture following orthotopic liver transplant (OLT) are rarely reported. We present 7 cases of clinically significant bile duct TNs following OLT and examine their role in the need for retransplantation.
Design: A retrospective review of our pathology database between 1/1/06 and 7/1/09 identified 17 patients that underwent hepatectomy with repeat transplant (n=16) or bile duct revision (n=1) at least 1 month following OLT. Sections of CBD were examined using H&E and an immunohistochemical stain for S100 protein and were reviewed by a neuropathologist masked to the study.
Results: Within the group, 10 (59%) demonstrated neural abnormalities of the CBD including 7 (41%) TNs and 3 (18%) lesions characterized as neural hyperplasia. All 7 cases of TN had radiographic and histological evidence of CBD stricture/compromise between 1 and 4.5 months (mean=3.4) following OLT, while the time to either revision or retransplant varied from 8 to 35 months (mean=19.6) (table 1). The donor bile duct appeared to be the origin of the TN in 5 cases (71%). There was an association with chronic hepatitis C infection in the TN cases when compared to non-TN cases requiring retransplant.
Conclusions: In our retrospective review, bile duct TNs were seen in every case of clinically significant CBD stricture leading to bile duct revision or retransplant. The majority of the TNs in our series appear to be of donor origin with a possible association with chronic hepatitis C infection. Of the remaining retransplant cases due to bile duct stricture formation, three cases demonstrated neural abnormalities in the form of hyperplasia, which may represent early, yet symptomatic lesions. We conclude the incidence may be significantly higher than what has been previously reported in the literature and should be considered in the differential when managing post-operative bile duct strictures.
Category: Liver & Pancreas
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 214, Monday Morning