A granular cell tumour (GCT), also known as Abrikossoff’s tumour, is an infrequent benign
neurogenic tumour, occurring ubiquitously but with a predilection for cutaneous and buccopharyngeal
sites [1,2]. It appears at between 40 and 50 years of age and seems to be more
frequent in women [1]. It is diagnosed exclusively from histological/immunohistochemical
analyses which show an origin in the Schwann cells with positive S100 protein labelling [3].
A biliary location is exceptional and mimics biliary cholangiocarcinoma in all aspects. Only
79 cases have been described in the literature [1—4]. The authors report an additional
case of a granular cell tumour of the proximal common bile duct.
Clinical case
A 40-year-old man with no medical history was hospitalised for cholestatic jaundice which
had developed over 45 days, with dark urine and normally coloured stools. His general state
of health had remained unaffected. Laboratory liver tests were disturbed with alkaline
phosphatase at 254 U/l (normal value 30—130 U/l) and total bilirubin at 50 mg/l (normal
value 3—10 mg/l), with predominance of conjugated bilirubin. A CT scan showed a tissue
process in the proximal common bile duct, with a long axis measuring 15 mm, that was
enhanced after contrast injection and occupied the lumen of the common bile duct (Fig. 1).
MRCP confirmed the biliary wall tumour mass, by revealing a T2-weighted hypointense
zone enhanced after injection of gadolinium chelates, which was responsible for proximal
bile duct stenosis with a preceding dilatation (Fig. 2). Cholangiocarcinoma was diagnosed
and the patient underwent resection of the proximal common bile duct with a Roux-en-
Y biliodigestive anastomosis and cholecystectomy. Histological examination revealed the
presence of tumour cells with eosinophilic granular cytoplasm and regular nuclei, with positive
immunostaining for S100 protein, on immunohistochemical examination, indicating a
granular cell tumour of the common bile duct. There were no postoperative complications
and the clinical outcome after 18 months was good