Contrast-enhanced ultrasound of a traumatic neuroma of the extrahepatic bile duct:A case report and review of literature

BACKGROUND Traumatic neuromas result from nerve injury after trauma or surgery but rarely occur in the bile duct.However,it is challenging to diagnose traumatic neuromas correctly preoperatively.Although some previous reports have described the imaging features of traumatic neuroma in the bile duct,no features of traumatic neuromas in the bile duct have been identified by using contrast-enhanced ultrasound(CEUS)imaging before.CASE SUMMARY A 55-year-old male patient presented to our hospital with a 3-mo history of abdominal distension and anorexia and history of cholecystectomy 4 years ago.Grayscale ultrasound demonstrated mild to moderate intrahepatic bile duct dilatation.Meanwhile,a hyperechoic nodule was found in the upper extrahepatic bile duct.The lesion approximately 0.8 cm×0.6 cm with a regular shape and clear margins.The nodule of the bile duct showed slight hyperenhancement in the arterial phase and isoenhancement in the venous phase on CEUS.Laboratory tests showed that alanine aminotransferase and aspartate aminotransferase were increased significantly,while the tumor marker carbohydrate antigen 19-9 was increased slightly.Then,hilar bile duct resection and end-to-end bile ductal anastomosis were performed.The histological examination revealed traumatic neuroma of the extrahepatic bile duct.The patient had an uneventful recovery after surgery.CONCLUSION The current report will help enhance the current knowledge regarding identifying traumatic neuromas by CEUS imaging and review the related literature.

Traumatic Neuromas in Breast Cancer Patients after Mastectomy

OBJECTIVE Traumatic neuromas are rare benign lesions occurring post-mastectomy,which are usually suspected as tumour recurrences before excision biopsy.We report six cases presenting with palpable nodules post-mastectomy,to emphasize the differential diagnosis of traumatic neuroma from recurrent cancer.METHODS Six cases were reviewed.The age of patients ranged from 33 to 61 years.Nodular masses were found close to the mastectomy scar during follow-up over a period of 2.8 to 8 years.RESULTS In one patient three nodular masses were detected.Five patients had received chemotherapy,three of which had also received ra-diotherapy.Ultrasound examinations showed a well-circumscribed,homoge-neous,hypo-echoic subcutaneous nodular lesion in four cases,and a poorly defined hypo-echoic nodule with good conduction in two cases.No obvious distant metastases had been identified.Each patient underwent surgical excisional biopsy.All of nodules had a diameter less than 1 cm.Histopatho-logical examination showed proliferation of nerve fibre bundles,which were disordered,oriented and well circumscribed in fibro-adipose tissue.CONCLUSION It was concluded that all of the lesions were traumatic neuromas,independent from the initial tumor.Traumatic neuromas occur-ring in mastectomy scars are difficult to distinguish from a tumor recurrence.Although radiological evaluation of the mass with ultrasound is of value,the diagnosis can only be confirmed following a histopathological evaluation.

A decellularized nerve matrix scaffold inhibits neuroma formation in the stumps of transected peripheral nerve after peripheral nerve injury

Traumatic painful neuroma is an intractable clinical disease characterized by improper extracellular matrix(ECM)deposition around the injury site.Studies have shown that the microstructure of natural nerves provides a suitable microenvironment for the nerve end to avoid abnormal hyperplasia and neuroma formation.In this study,we used a decellularized nerve matrix scaffold(DNM-S)to prevent against the formation of painful neuroma after sciatic nerve transection in rats.Our results showed that the DNM-S effectively reduced abnormal deposition of ECM,guided the regeneration and orderly arrangement of axon,and decreased the density of regenerated axons.The epineurium-perilemma barrier prevented the invasion of vascular muscular scar tissue,greatly reduced the invasion ofα-smooth muscle actin-positive myofibroblasts into nerve stumps,effectively inhibited scar formation,which guided nerve stumps to gradually transform into a benign tissue and reduced pain and autotomy behaviors in animals.These findings suggest that DNM-S-optimized neuroma microenvironment by ECM remodeling may be a promising strategy to prevent painful traumatic neuromas.

Regenerative peripheral nerve interface prevents neuroma formation after peripheral nerve transection

Neuroma formation after peripheral nerve transection often leads to severe neuropathic pain.Regenerative peripheral nerve interface has been shown to reduce painful neuroma in the clinic.However,no reports have investigated the underlying mechanisms,and no comparative animal studies on regenerative peripheral nerve interface and other means of neuroma prevention have been conducted to date.In this study,we established a rat model of left sciatic nerve transfection,and subsequently interfered with the model using the regenerative peripheral nerve interface or proximal nerve stump implantation inside a fully innervated muscle.Results showed that,compared with rats subjected to nerve stump implantation inside the muscle,rats subjected to regenerative peripheral nerve interface intervention showed greater inhibition of the proliferation of collagenous fibers and irregular regenerated axons,lower expressions of the fibrosis markerα-smooth muscle actin and the inflammatory marker sigma-1 receptor in the proximal nerve stump,lower autophagy behaviors,lower expressions of c-fos and substance P,higher expression of glial cell line-derived neurotrophic factor in the ipsilateral dorsal root ganglia.These findings suggested that regenerative peripheral nerve interface inhibits peripheral nerve injury-induced neuroma formation and neuropathic pain possibly via the upregulation of the expression of glial cell line-derived neurotrophic factor in the dorsal root ganglia and reducing neuroinflammation in the nerve stump.

Ultrasound-guided needle release plus corticosteroid injection of superficial radial nerve:A case report

BACKGROUND The radial nerve(RN)splits into two main branches at the elbow:The superficial branch of RN(SBRN)and the deep branch of RN.The SBRN can be easily damaged in acute trauma due to its superficial feature.CASE SUMMARY A 55-year-old male patient injured his right wrist 10 mo ago.Debridement,suturing and bandaging were performed in the emergency room.Six months after the scar had healed,he felt numbness and tingling in the dorsal surface of the thumb of the right hand.So the surgery of resection and SBRN anastomosis were performed.The pathological findings showed it as traumatic neuroma.Four months after surgery,the patient felt numbness and tingling in the right dorsal surface of the thumb again.The tenderness was marked in the operated area.Ultrasound indicated that the SBRN was adhered to the surrounding tissue.The patient refused further surgical treatment and underwent ultrasound-guided needle release plus corticosteroid injection of the SBRN.Four weeks later,the tenderness in the surgical area was reduced by 70%,the numbness in the dorsal surface of the thumb of the right hand was reduced by 40%and the nerve swelling evaluated by ultrasound was reduced.Four months passed,he did not feel any numbness or tingling sensation of his right wrist.This is the first report of ultrasound-guided needle release plus corticosteroid injection of the SBRN.CONCLUSION Ultrasound can evaluate the condition of the RN,and the relationship with surrounding tissues.Ultrasound-guided needle release plus corticosteroid injection is an effective and safe treatment for SBRN adhesion.

Case report of a traumatic rectal neuroma

Traumatic neuroma is a well-recognized complication of lower extremity amputation,yet has also been noted to occur elsewhere.We report a clinical case and English-language literature review of traumatic rectal neuroma,a well-known pathologic entity not previously reported in this anatomic location.