Traumatic neuroma around the celiac trunk after gastrectomy mimicking a nodal metastasis: a case report.
ABSTRACT Traumatic neuroma is a well-known disorder that occurs after trauma or surgery involving the peripheral nerve and develops from a nonneoplastic proliferation of the proximal end of a severed, partially transected, or injured nerve. We present a case of traumatic neuroma around the celiac trunk after gastrectomy in a 56-year-old man, which was confirmed by pathology. CT demonstrated the presence of a lobulated, homogeneous, hypoattenuating mass around the celiac trunk, mimicking a nodal metastasis.
Article: From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation.[show abstract] [hide abstract]
ABSTRACT: Numerous neurogenic tumors can affect the musculoskeletal system, including traumatic neuroma, Morton neuroma, neural fibrolipoma, nerve sheath ganglion, neurilemoma, neurofibroma, and malignant peripheral nerve sheath tumors (PNSTs). The diagnosis of neurogenic tumors can be suggested from their imaging appearances, including lesion shape and intrinsic imaging characteristics. It is also important to establish lesion location along a typical nerve distribution (eg, plantar digital nerve in Morton neuroma, median nerve in neural fibrolipoma, large nerve trunk in benign and malignant PNSTs). Traumatic and Morton neuromas are commonly related to an amputation stump or are located in the intermetatarsal space, respectively. Neural fibrolipomas show fat interspersed between nerve fascicles and are often associated with macrodactyly. Nerve sheath ganglion has a cystic appearance and commonly occurs about the knee. Radiologic characteristics of neurilemoma, neurofibroma, and malignant PNST at computed tomography (CT), ultrasonography, and magnetic resonance imaging include fusiform shape, identification of entering and exiting nerve, low attenuation at CT, target sign, fascicular sign, split-fat sign, and associated muscle atrophy. Although differentiation of neurilemoma from neurofibroma and of benign from malignant PNST is problematic, recognition of the radiologic appearances of neurogenic tumors often allows prospective diagnosis and improves clinical management of patients.Radiographics 19(5):1253-80. · 2.85 Impact Factor
Article: Traumatic neuroma and recurrent lymphadenopathy after neck dissection: comparison of radiologic features.[show abstract] [hide abstract]
ABSTRACT: To retrospectively evaluate the ultrasonographic (US), computed tomographic (CT), and magnetic resonance (MR) imaging features that differentiate traumatic neuroma from recurrent lymphadenopathy after neck dissection. Imaging findings of 10 patients with a traumatic neuroma and 17 with recurrent lymphadenopathy were reviewed. US and CT were performed in all patients; MR imaging was performed in 16 patients. Findings analyzed at US included the diameter of the long and short axes, the short-axis-to-long-axis ratio, and the presence of a central hyperechoic area. Findings analyzed at CT were contiguity with common or internal carotid artery, lesion location in correlation with carotid artery, and the presence of a hyperattenuating rim. Findings analyzed at MR imaging included signal intensity on T1- and T2-weighted images, the presence of ring enhancement, and the presence of a hypointense rim on T2-weighted images. Statistically significant differences were found between traumatic neuroma and recurrent lymphadenopathy in the short-axis-to-long-axis ratio (mean, 0.47 vs 0.72; P < .001), the short-axis diameter (mean, 5.7 vs 12.2 mm; P < .001), the presence of a central hyperechoic area (five of 10 patients [50%] vs one of 17 patients [6%]; P < .05), the frequency of contact with carotid artery (two of 10 patients [20%] vs 13 of 17 patients [76%]; P < .01), and the presence of a hypointense rim on T2-weighted MR images (three of six patients [50%] vs zero of 10 patients [0%]; P < .05). Findings in other parameters were not statistically significant. Several imaging findings can differentiate traumatic neuroma from recurrent lymphadenopathy after neck dissection.Radiology 12/2004; 233(2):523-9. · 5.73 Impact Factor
[show abstract] [hide abstract]
ABSTRACT: Jaundice and stricture of the common hepatic duct were detected in a 53-yr-old woman 2 months after she had laparoscopic cholecystectomy for a gallstone. Then she underwent resection of the stricture part of the duct and hepaticojejunostomy which was effective. Pathological examination showed that traumatic neuroma, probably caused by bile leakage after cauterization, led to stricture of the common bile duct.The American Journal of Gastroenterology 11/1995; 90(10):1887-8. · 7.28 Impact Factor
Korean J Radiol 8(3), June 2007
Traumatic Neuroma around the Celiac
Trunk after Gastrectomy Mimicking a
Nodal Metastasis: A Case Report
Traumatic neuroma is a well-known disorder that occurs after trauma or
surgery involving the peripheral nerve and develops from a nonneoplastic prolif-
eration of the proximal end of a severed, partially transected, or injured nerve. We
present a case of traumatic neuroma around the celiac trunk after gastrectomy in
a 56-year-old man, which was confirmed by pathology. CT demonstrated the
presence of a lobulated, homogeneous, hypoattenuating mass around the celiac
trunk, mimicking a nodal metastasis.
raumatic neuroma is a well-known disorder that occurs after trauma or
surgery involving the peripheral nerve and develops from a nonneoplas-
tic proliferation of the proximal end of a severed, partially transected, or
injured nerve (1, 2). However, in the abdomen, traumatic neuromas have been
sporadically reported to occur in the bile duct (3 7). We present here a case of
traumatic neuroma around the celiac trunk after gastrectomy that mimicks a nodal
A 56-year-old man presented with a lobulated mass around the celiac trunk. This
patient had undergone a distal gastrectomy with gastroduodenostomy for early gastric
cancer nine years previously and a subtotal gastrectomy with gastrojejunostomy for
recurred gastric cancer in the remnant stomach five months previously. According to
the 5th American Joint Committee on Cancer (AJCC) TNM classification, the recurred
gastric cancer was a stage II lesion (T3 N0 M0) based on the pathology (Fig. 1A). On
the present admission, the patient showed no apparent discomfort and a physical
examination was normal. The laboratory tests showed no abnormal findings. The
carcinoembryonic antigen level was 1.6 ng/mL (< 5.0 ng/mL) and the serum carbohy-
drate antigen 19 9 level was 5.7 U/mL (< 39 U/mL).
A three-phase CT scan showed a lobulated, mildly enhanced, homogeneous, hypoat-
tenuating mass just distal to the celiac trunk (Figs. 1B E). This mass encased the
common hepatic artery, splenic artery, proper hepatic artery, and the gastroduodenal
artery (Figs. 1B, C). However, CT angiography showed no luminal narrowing or
irregularities of these arteries (Fig. 1F). A fluorodeoxyglucose (FDG)-positron emission
tomographic (PET) scan showed no increased uptake in the celiac region (mean
standardized uptake value of 3.2) (Fig. 1G). Because it was difficult to distinguish a
benign mass from a nodal metastasis, a decision was made to perform surgery.
During surgery, an ill-defined, irregular, pale tan, firm mass was seen around the
Jung Hyeok Kwon, MD1
Seung Wan Ryu, MD2
Yu Na Kang, MD3
Korean J Radiol 2007;8:242-245
Received September 17, 2006; accepted
after revision February 6, 2007.
Department of 1Diagnostic Radiology,
2Surgery, 3Pathology, Dongsan Medical
Center, Keimyung University School of
Medicine, Daegu 700-712, Korea
Address reprint requests to:
Jung Hyeok Kwon, MD, Department of
Diagnostic Radiology, Dongsan Medical
Center, Keimyung Univesity School of
Medicine, 194 Dongsan-dong, Jung-gu,
Daegu 700-712, Korea.
Tel. (8253) 250-7770
Fax. (8253) 250-7766
Traumatic Neuroma Mimicking Nodal Metastasis
Korean J Radiol 8(3), June 2007
Fig. 1. A 56-year-old man with traumatic neuroma around the celiac trunk.
A. A contrast-enhanced abdominal CT scan in the arterial phase showed no mass present around the celiac trunk 5 months previously.
B, C. Contrast-enhanced abdominal CT scans in the arterial phase show a lobulated hypoattenuating soft tissue mass in the celiac
region encasing the common hepatic artery, splenic artery, gastroduodenal artery, and the proper hepatic artery.
D, E. Contrast-enhanced abdominal CT scans in the portal phase (D) and equilibrium phase (E) show a mild homogeneous enhance-
ment of this mass.
F. Volume-rendering CT angiography shows that the celiac trunk and its tributaries are patent without vessel wall irregularities, or vessel
celiac trunk. A frozen section revealed the presence of
fibrotic connective tissue without malignant cells, and the
proliferation of neural tissue. The tumor mass was resected
in several pieces (Fig. 1H). The size of the mass was 3.0
3.5 1.0 cm in aggregates. A histologic examination
showed proliferation of neural tissue and fibrotic change,
but there was no evidence of definite malignant cells. The
celiac mass consisted of small and large proliferating
fascicles of nerve in a background of collagen and fat tissue
(Fig. 1I, J). These findings were compatible with the
presence of a traumatic neuroma.
On a follow up CT scan performed seven months later,
there was no evidence of a soft tissue mass in the celiac
Traumatic or amputation neuroma is a well-known
disorder that occurs 1 12 months after trauma or surgery
involving the peripheral nerve. Rather than representing a
neoplasm, neuroma represents a reactive hyperplasia of
nerve tissue and usually occurs at the proximal end of a
severed nerve (2).
In the abdomen, neuromas have been reported to occur
in the bile duct after cholecystectomy (3, 4), bile duct
surgery (5), orthotopic liver transplantation (6), and blunt
abdominal trauma (7). The neuromas occur as most of the
common bile duct is surrounded by a delicate net of
sympathetic and parasympathetic nerve fibers that are
derived from the celiac plexus. Most patients have no
Kwon et al.
Korean J Radiol 8(3), June 2007
Fig. 1. G. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) image shows no increased uptake around the celiac trunk
with a mean standardized uptake value of 3.2.
H. The resected celiac mass is composed of several pieces of irregular pale tan to yellow firm tissue, measuring 3.5
I, J. Microscopically, the celiac mass consists of small (arrows) and large (asterisk) proliferating fascicles of nerve in a background of
collagen and fat tissue (Hematoxylin & Eosin staining,
100). The celiac mass is composed of a haphazard proliferation of nerve
fascicles, including axons with their investitures of myelin, Schwann cells, and fibroblasts (Hematoxylin & Eosin staining,
3.0 1.0 cm in
Traumatic Neuroma Mimicking Nodal Metastasis
Korean J Radiol 8(3), June 2007
symptoms, but some patients have upper abdominal pain
and jaundice. Treatment of this disorder is unnecessary
unless the patient has symptoms.
The celiac plexus, surrounding the root of the celiac
arterial trunk, are nerve networks consisting of both
sympathetic and parasympathetic fibers. Injury to celiac
plexus during lymph node dissection for gastric surgery is
Arterial invasion can be suggested with high specificity
when either arterial embedment, tumor involvement
exceeding one-half of the circumference of the vessel,
vessel wall irregularities, or vessel caliber stenosis is
present (8). In the present case, the mass encircled the
whole circumference of multiple vessels, but in any of the
encircled vessels, wall irregularity or vessel caliber stenosis
was not seen with CT angiography. This finding may be
unusual to a malignant tumor.
The tumor was homogeneous and hypovascular in
arterial, portal, and equilibrium phases of an enhanced CT
scan. There was also no increased uptake of FDG on the
FDG-PET scan, suggestive of the presence of a benign
FDG is not a cancer-specific agent. False positive findings
have been reported in cases of active inflammation and
infection, and malignant tumors with low metabolic
activity or tumors smaller than 1.0 cm in diameter often
show false negative results (9). In detecting local lymph
node metastasis from stomach cancer, the sensitivity of
PET was lower than that of CT, and the specificity was
higher. However, the overall accuracy of PET was not
significantly different from that of CT in detecting both
local (63% vs. 75%) and distant (95% vs. 89%) lymph
node metastasis (10).
Our initial impression suggested that the mass was a
conglomerated nodal metastasis or postoperative
granuloma. A preoperative diagnosis of traumatic neuroma
is difficult to make, despite all modern imaging techniques,
and in most cases, a final diagnosis is made at surgery.
In conclusion, the imaging finding of traumatic neuroma
around the celiac trunk was a homogeneous hypovascular
mass without narrowing or irregularity of encased arteries
and without increased uptake on PET-CT. Although from a
clinical standpoint, establishing an accurate preoperative
diagnosis is difficult to perform, the presence of a traumatic
neuroma should be included in the differential diagnosis of
a mass around the celiac trunk in a patient that has
undergone celiac nodal dissection.
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