Nerve Infiltration by Benign Biliary Glands – A Diagnostic Dilemma

Abstract

Perineural and intraneural infiltration is most often considered a diagnostic feature of malignancy but has been demonstrated in benign entities in a variety of organs.

This brief report describes benign glands apparently infiltrating nerves around bile ducts in a resected extra-hepatic biliary tree performed on a background of recurrent cholangitis and prior cholecystectomy. To our knowledge, benign glands infiltrating nerves within bile ducts has not been reported outside of the setting of end stage primary sclerosing cholangitis where one example has been described.

We identify several features which support the benign nature of this process including bland cytomorphology, identical appearance to adjacent glands and an exuberant neural rather than glandular proliferation supporting the probability of a reactive neural proliferation akin to traumatic neuroma.

We propose a pathogenesis that is somewhat analogous to traumatic neuroma of the biliary tree which, despite its rarity, is a documented complication of cholecystectomy, comprising a reactive proliferation of nerve tissue in response to injury.

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