
Home
Case
of Week Home
Jobs
Conferences
Fellowships
Books
8 October 2014 - Case of the Week #329
All cases are archived on our website. To view them sorted by number, diagnosis or category, visit our Home Page and click on the Case of the Week button on the left hand side. To subscribe or unsubscribe to the Case of the Week or our other email lists, click here.
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.
- Do you use Amazon.com? You can support our free website just by making an Amazon purchase, IF you enter Amazon through a banner or link on our website (above), or by clicking here. Amazon uses third parties to market their website, and pays out of the money they receive - it doesn't cost you anything extra.
- Robbins and Cotran Review of Pathology, 4th Edition by Edward Klatt and Vinay Kumar. Effectively master the most important principles and facts in pathology with this easy-to-use new edition of Robbins and Cotran Review of Pathology. More than 1,100 questions-reviewed and updated to reflect the new content in the parent text-reinforce the fundamentals of gross and microscopic pathology as well as the latest findings in molecular biology and genetics. This review book of multiple choice questions and answers, companion to Robbins and Cotran Pathologic Basis of Disease 9th Edition and Robbins Basic Pathology, 9th Edition, is the ideal study tool for coursework, self-assessment, and examinations, including the USMLE Step 1 examination in pathology. For more information, visit our Books page.
Advertisement
Website news:
(1) We are pleased to report 46 paid Pathologist/PhD Job postings in September 2014, the second largest monthly total in our history (the largest was 48 postings in September 2012). Overall, paid Pathologist/PhD Job postings are up 20% in the first 9 months of 2014 compared to 2013. To improve / maintain customer satisfaction, we continue to focus on rapid posting of ads, proofreading of ads by a pathologist, excellent customer service, and generating more traffic to the website. We will provide Job statistics in the Quarter 3 - 2014 Pathologist Jobs Report, to be posted by 30 October 2014.
We also posted a record number of 18 Fellowship ads in September 2014.
Finally, sales through Amazon.com are up 39% in the first 9 months of 2014 compared to 2013. This helps our website without costing you anything. Simply visit Amazon.com by clicking on one of our Amazon links or banners (on Home page and other pages) and Amazon will pay us ~ 5% of your purchase price, out of their profits. Contact us with any questions at 248/646-0325 or info@pathologyoutlines.com.
(2) Don't forget to check out our new Mystery case on the right side of our Home page.
(3) For September 2014, we had record numbers of total visits (627,850) and average daily visits (20,928). Thanks for your support!
(4) Looking to print a page off our website? Use PrintFriendly.com, a free, easy to use website.
(5) Remember if you want to search for a topic on our website, use the Google search bar at the top of our Home page. Also, the 'cached' feature can still be found by using the Google search bar on the bottom of our Home Page.
(6) Visit our Updates page to see what topics have been revised based on reviews or new images.
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.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email:
NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com