PMC5925028_01
(a and b) Representative axial and coronal images from contrast enhanced preoperative MRI of the patient. Encasement of hepatic artery with extension of the mass predominantly towards the right side is noted in GB fossa. (c & d) Follow-up postoperative CT scans 5 years later depicting almost stable appearance of the mass.
HPB2018-7814763.002.jpg
PMC5925028_01_HPB2018-7814763.002.jpg
fig2
T2 hyperintense mass encasing the hepatic artery and portal vein within the PH (Figures 2(a) and 2(b)). There was no loss of signal on the out-of-phase images. The preoperative diagnosis for this mass was felt to be a neurofibroma. Over a period of six years the mass has remained stable.  Figure 2 shows the preoperative and postoperative representative images of the PNF along with gross and histopathologic images.
(a) Gross morphology of "Mass in Gallbladder." Note the lobulated and nodular overall surface resembling a "bag of worms." The mass measured in total 3.2 x 2.2 x 1.3 cm. (b) Plexiform neurofibroma involving the muscularis propria of the gallbladder wall (H&E, 200x). (c) Higher magnification highlights the loosely arranged spindle shaped cells of plexiform neurofibroma with peripheral entrapment of native ganglion cells (H&E, 400x). (d) Plexiform neurofibroma residing within the fibrofatty tissue adjacent to the gallbladder. (H&E, 200x) (inset) plexiform neurofibroma showing typical histologic findings with loosely arranged comma-shaped nuclei in a myxoid stroma (H&E, 600x).
HPB2018-7814763.003.jpg
PMC5925028_01_HPB2018-7814763.003.jpg
fig3
Surgical pathology revealed plexiform neurofibroma involving the gallbladder without any evidence of malignant transformation.  Figure 3 highlights the gross and histopathologic features of PNF.