Mackenzie D J, Klapper E, Gordon L A, Silberman A W
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048.
Med Pediatr Oncol. 1994;23(1):50-6. doi: 10.1002/mpo.2950230109.
Granular cell tumors (GCT) are rare benign neoplasms of Schwann cell origin which have been found in virtually every location in the body. Their location in the biliary system is unusual, and typically occurs in black females during the fourth decade of life. Forty-eight cases have been reported since 1952. We present two patients treated for obstructive jaundice caused by GCT of the extrahepatic biliary tree. The literature on biliary GCT is reviewed and their management is outlined. Local excision with Roux-y-hepaticojejunostomy was performed in one patient with GCT obstructing the common bile duct at the level of the cystic duct. Pancreaticoduodenectomy was performed on one patient for GCT of the common bile duct involving the ampulla and adjacent pancreas. GCT of the extrahepatic biliary system are rare but should be considered in black females who present with obstructive jaundice in the fourth decade of life. Local excision with cholecystectomy and reconstruction of the biliary remnant is indicated. Primary biliary anastomosis is desired but choledochojejunostomy or hepaticojejunostomy may be necessary. Rarely, pancreaticoduodenectomy may be indicated in GCT of the distal common bile duct.
颗粒细胞瘤（GCT）是一种罕见的起源于施万细胞的良性肿瘤，几乎在身体的每个部位都有发现。它们在胆道系统中的位置不常见，通常发生在40岁左右的黑人女性中。自1952年以来，已有48例相关病例报道。我们报告了两名因肝外胆管颗粒细胞瘤导致梗阻性黄疸而接受治疗的患者。本文回顾了有关胆道颗粒细胞瘤的文献并概述了其治疗方法。一名颗粒细胞瘤阻塞胆囊管水平胆总管的患者接受了局部切除联合Roux-y肝空肠吻合术。一名胆总管颗粒细胞瘤累及壶腹和邻近胰腺的患者接受了胰十二指肠切除术。肝外胆道系统颗粒细胞瘤很少见，但对于40岁左右出现梗阻性黄疸的黑人女性应予以考虑。建议进行局部切除联合胆囊切除术及胆道残端重建。理想情况下应进行一期胆肠吻合，但可能需要胆总管空肠吻合术或肝空肠吻合术。极少数情况下，胆总管远端颗粒细胞瘤可能需要进行胰十二指肠切除术。
