Traumatic neuroma of remnant cystic duct mimicking duodenal subepithelial tumor: A case report

Figure 1 Preoperative tumor evaluation. A: Upper gastrointestinal endoscopy showing a lesion protruding into the lumen of the duodenal bulb; B: Endoscopic ultrasonography showing a hypoechoic lesion 1.8 cm in size; C: Coronary view of abdominal computed tomography (CT) showing a small enhancing nodule 1.4 cm in size (orange arrow) between the cystic duct and the duodenal bulb; D: Axial view of abdominal CT showing the lesion (orange arrow).

Figure 2 Histological findings of tumor and specimen. A: Microscopic view of a neuroma showing spindle cell proliferation arranged in short bundles and intervening cleft artifact (white arrows, hematoxylin and eosin staining; magnification x 200); B: Lesion tests positive for S100 protein; C: Macroscopic findings of resected duodenal wall (yellow arrow), lesion (orange arrow), and cystic duct (white arrow); D: Incised specimen showing a hard mass (blue arrow) with the cystic portion (orange arrow) adjacent to the duodenal wall (yellow arrow) and the cystic duct (white arrow).

Figure 3 Operative procedure of laparoscopic endoscopic cooperative surgery for duodenal neoplasms. A: Lesion (yellow arrow) between the duodenal bulb and common bile duct; B: Partial perforation of the duodenal wall using insulation-tipped electrosurgical knife during endoscopy; C: Lesion (yellow arrow) is difficult to identify between the resected duodenal wall (white arrow) and cystic duct (black arrow); D: View after resection of lesion and repair of duodenal wall.