Korean J Gastroenterol.  2016 Nov;68(5):279-283. 10.4166/kjg.2016.68.5.279.

Traumatic Neuroma at the Inferior Mesenteric Artery Stump after Rectal Cancer Surgery: A Case Report and Literature Review

• Jeon SM
• Lee JY
• Byeon SJ

• KMID: 2383507
• DOI: http://doi.org/10.4166/kjg.2016.68.5.279

Abstract

Traumatic neuroma results from regeneration attempts of the proximal end of an injured or severed nerve, resulting in a non-neoplastic nodular lesion. The lower extremity after amputation is the most common site, followed by the head and neck. Traumatic neuromas occurring in the abdomen, however, are rare. In the abdominal region, traumatic neuromas occur in the cystic duct stump and the common bile ducts as well as around the celiac trunk. This study reports a case of a 59-year-old man who presented with a traumatic neuroma arising at the stump of the inferior mesenteric artery after rectal cancer surgery. Traumatic neuromas at the stump of the inferior mesenteric artery have not been previously reported. The lesion exhibited atypical imaging features, including a well-enhanced nodule, a significant interval growth in size and a mild increase in 18F-fluorodeoxyglucose uptake, resembling lymph node metastasis. This case report will help physicians understand the sites of occurrence and imaging features of traumatic neuromas in the abdomen.

Keyword

Neuroma; Trauma; Injuries; Rectal neoplasms; Inferior mesenteric artery

MeSH Terms

Abdomen
Amputation
Common Bile Duct
Cystic Duct
Head
Humans
Lower Extremity
Lymph Nodes
Mesenteric Artery, Inferior*
Middle Aged
Neck
Neoplasm Metastasis
Neuroma*
Rectal Neoplasms*
Regeneration

Figure

• 

  Fig. 1. An ill-defined left para-aortic lesion on CT images obtained two weeks after surgery. (A) Non-contrast CT reveals an ill-defined infiltrative para-aortic soft tissue attenuation lesion (arrow, 30.53±27.25 HU) at the inferior mesenteric artery stump area. (B) Portal-venous phase CT indicates that the lesion (arrow) is persistently enhancing (53.64±28.65 HU). This lesion was interpreted as a postoperative granulation tissue because the occurrence of a lesion at a stump is considered a typical finding.

• 

  Fig. 2. A left para-aortic lesion changing into a discrete nodule on follow-up CT scans. (A) Portal-venous phase CT obtained seven months after operation depicts a 1.2 cm discrete enhancing nodule (arrow) at the inferior mesenteric artery stump area (73.17±10.37 HU). (B) Portal-venous phase of a contrastenhanced CT obtained 20 months after operation depicts a 1.2 cm discrete enhancing mass (arrow) at the inferior mesenteric artery stump area (96.16±14.04 HU) at the portal-venous phase. No significant interval change in size is noted compared with the previous CT (Fig. 2A). (C) Portal-venous phase of a contrastenhanced CT obtained 32 months after operation reveals a 1.8 cm discrete enhancing mass (arrows) at the inferior mesenteric artery stump area (110.00±14.30 HU) at the portal-venous phase. An interval increase in size is noted compared with the previous CT (1.2 cm to 1.8 cm). Coronal portal-venous phase image also reveals a well-demarcated slightly elongated mass (arrows) at the left para-aortic area.

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  Fig. 3. A hypermetabolic lesion at the left para-aortic area. A 18F-fluorodeoxyglucose PET-CT scan depicts a hypermetabolic lesion (arrows) at the left para-aortic inferior mesenteric artery stump area (standardized uptake value, 2.87).

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  Fig. 4. Microscopic findings (H&E). (A) The lesion is composed of variably sized proliferating nerve fascicles in a background of collagen and adipose tissue (×12). (B) The image reveals haphazard proliferation of nerve fascicles including axons, Schwann cells, and fibroblasts (×200).

Reference

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