2020 Volume 62 Issue 3 Pages 351-357
An 83-year-old woman who had undergone cholecystectomy for cholecystolithiasis at the age of 40 years presented with pain in the right hypochondriac region. Laboratory analysis showed elevated levels of hepatic and biliary enzymes. Computed tomography revealed an enhanced nodule at the junction of the cystic duct. Peroral cholangioscopy revealed a smooth protrusion that was covered with normal mucosa at the junction of the cystic duct. An amputation neuroma was suspected; thus, we performed cholangioscopy-guided boring biopsy to sample the submucosal tissue. Histopathological examination of the biopsy specimen showed connective tissue containing S-100 protein-positive nerve fibers; this finding is consistent with an amputation neuroma. The patient presented with symptoms secondary to biliary obstruction; therefore, extrahepatic bile duct resection and hepaticoduodenostomy were performed. The postoperative histopathological diagnosis was amputation neuroma of the cystic duct remnant. It is difficult to diagnose amputation neuroma by imaging, and boring biopsy under peroral cholangioscopy is useful for histological diagnosis before surgery is performed.
