Clinical, Pathological, and Immunohistochemical Features of Adenomyoma in the Ampulla of Vater

Abstract

Background/Aims: Ampullary adenomyoma is a benign lesion whose malignant potential has yet to be confirmed. Despite its benign nature, adenomyoma is frequently misdiagnosed as a carcinoma or adenoma and is overtreated by extensive surgery.This study was performed to analyze the clinical, pathological, and immunohistochemical features of adenomyomas in the ampulla of Vater. Methods: Nine cases of adenomyoma in the ampulla of Vater, diagnosed in Chungbuk National University Hospital between 2008 and 2011, were enrolled in this study. We reviewed the clinical data on the symptoms, laboratory data, and radiologic findings of the abdominal computed tomography and endoscopic retrograde cholangiopancreatography. For pathological analysis, all the slides were reviewed by one pathologist, and immunohistochemical stainings with antibodies against cytokeratin 7 (CK7), cytokeratin 20 (CK20), α-smooth muscle actin (α-SMA), and Ki-67 antigen were performed. Results: All the cases were CK7 positive and CK20 negative. A strong cytoplasmic expression of α-SMA was confirmed in all cases. The Ki-67 index was less than 1% in eight cases and 5% in one case. Four cases underwent endoscopic papillectomy, and one case received surgical ampullectomy during colorectal cancer surgery. Five cases that underwent endoscopic or surgical treatment remained symptom-free for three years. Four cases that were closely observed with repeated endoscopic examinations exhibited no interval changes in the papillary lesions. Conclusions: Endoscopic biopsy and immunohistochemistry can aid in the diagnosis of ampullary adenomyomas. Endoscopic papillectomy or surgical ampullectomy is adequate for the treatment of symptomatic ampullary adenomyomas. (Korean J Gastroenterol 2013;62:352-358)

Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature

“…For our case, histology demonstrated glandular structures that were surrounded by a fibroblastic or myofibroblastic proliferation. Reported symptoms for these rare cases are nonspecific and include jaundice, abdominal pain, nausea, vomiting, dysphagia, and unintentional weight loss[1,3,7]. A dilated CBD is common and sometimes presents intermittently in the adenomyoma of the Vaterian system[1,3].…”

Combination of Adenomyoma and Adenomyomatous Hyperplasia of the Ampullary System: A First Case Report

“…1,2 Due to the difficulty in recognizing the nature of these lesions (ie, the clinical symptoms and radiological and pathological features can resemble those of a neoplasm), patients may undergo extensive surgery. 3,4 According to the World Health Organization classification, adenomyoma and adenomyomatous hyperplasia are benign tumor-like lesions. 5 Usual findings are typically present in gallbladder specimens, while only a few cases have been reported elsewhere in the gastrointestinal tract, including the stomach, small bowel, biliary tree, and ampulla.…”

“…3 The histogenesis of this tumor-like lesions is still poorly characterized. Regarding the ampullary location, fewer than 60 cases involving the major papilla have been reported, 3,4,6 and only one case involving the minor papilla has been reported. 7 We report an unusual association of a major duodenal papilla adenomyoma with an adenomyomatous hyperplasia of the minor papilla discovered in a 73-year-old patient who underwent cephalic duodenopancreatectomy due to clinical and radiological evidence of underlying malignant neoplasm.…”

Diagnostic Accuracy of the Initial Endoscopy for Ampullary Tumors

“…A wide variety of tumors, including neoplasms such as neuroendocrine tumors, adenomas, and adenocarcinomas, as well as non-neoplasms such as inflammatory tumors, lipomas, lymphangiomas, fibromas, adenomyomas, and hamartomas, arise at the ampulla of Vater (AoV). 1 , 2 , 3 , 4 , 5 , 6 Endoscopy is the most valuable method of identifying ampullary tumors. Observation of macroscopic appearance and biopsy specimens can be performed during routine endoscopy.…”