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Presented by Ralph Hruban, M.D. and prepared by Jon Davison, M.D.
Case 6: This 50 some year old female had a liver transplant for primary sclerosing cholangitis.
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Week 188: Case 6
This 50 some year old female had a liver transplant for primary sclerosing cholangitis. Months after transplant she developed signs and symptoms of biliary obstruction.images/JMD 6-14-04 SPWC/Case 6/a.jpg
images/JMD 6-14-04 SPWC/Case 6/b.jpg
images/JMD 6-14-04 SPWC/Case 6/c.jpg
images/JMD 6-14-04 SPWC/Case 6/d.jpgCorrect
Answer: Traumatic neuroma obstructing the bile duct
Histology: The bile duct is surrounded and compressed by poorly organized bundles of nerve fibers.
Discussion: In this case a traumatic neuroma obstructing the bile duct clinically mimicked recurrent primary sclerosing cholangitis. When evaluating pathology from a transplant recipient, it can be useful to consider the timing of the pathology relative to the transplant. Common complications in the immediate post-transplant period include hyperacute rejection and surgical complications. Complications in the intermediate post-transplant period (weeks to months) include infection and rejection. Long-term (months to years) complications include chronic rejection and neoplasms (both post-transplant lymphoproliferative disorder and neoplasms that occur in the non-transplanted population).
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Incorrect
Answer: Traumatic neuroma obstructing the bile duct
Histology: The bile duct is surrounded and compressed by poorly organized bundles of nerve fibers.
Discussion: In this case a traumatic neuroma obstructing the bile duct clinically mimicked recurrent primary sclerosing cholangitis. When evaluating pathology from a transplant recipient, it can be useful to consider the timing of the pathology relative to the transplant. Common complications in the immediate post-transplant period include hyperacute rejection and surgical complications. Complications in the intermediate post-transplant period (weeks to months) include infection and rejection. Long-term (months to years) complications include chronic rejection and neoplasms (both post-transplant lymphoproliferative disorder and neoplasms that occur in the non-transplanted population).
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