Adenomyoma of the gastrointestinal tract has been considered to be a form of pancreatic heterotopia. Heterotopic pancreatic tissue in the gastrointestinal tract is a relatively not uncommon abnormality, but adenomyoma is a rarely reported tumor and its ineidence is difficult to determine. Adenomyoma is similar to aberrant pancreas in both appearance and location, and cannot be differentiated endoscopically or radiographically. Histologically, adenomyoma is primarily composed of smooth muscle and undifferentiated duct like structures. It is usually of no clinical importance and incidentally detected, but according to its location and size of the mass, it may become a serious clinical problem. Its real importance lies in the recognition of its existence, to facilitate a timely diagnosis, We present a case of adenomyoma of the duodenum with a brief literature review.
Adenomyoma* ; Diagnosis ; Duodenum* ; Esophagus* ; Gastrointestinal Tract ; Intestines* ; Muscle, Smooth ; Pancreas ; Stomach*

PURPOSE: A laparoscopic cholecystectomy is now the gold standard for the treatment of gallstone disease. While the widespread use of ultrasonography has increased the frequency of the diagnosis of polypoid lesions of the gallbladder (PLG), no optimal strategies for evaluating and treating these lesions have been established. The aims of this study were to identify the risk factors for malignancy, and evaluate the usefulness of laparoscopic cholecystectomy for PLG. METHODS: The clinical and histopathological data from ninety PLG patients, who received a laparoscopic cholecystectomy, between January 1998 and December 2005, were retrospectively analyzed. Data were evaluated using a multiple logistical regression analysis. RESULTS: There were 82 benign PLG, including 38 cholesterol polyps, 22 adenomas, 18 hyperplastic polyps and 4 adenomyomas, and 8 malignant PLG. The average age of the patients with malignant PLG was significantly older than that of those with benign PLG (P=0.001). The average malignant PLG diameter was significantly larger than that of the benign PLG (P=0.000). The malignant PLG were mostly a single lesion; whereas, half of the benign PLG were multiple lesions. In the multiple logistical regression analysis, polyp sizes greater than 1.5 cm and an age over 50 years were the two most important factors for predicting malignancy of PLG. Seven of eight patients with malignant PLG are still alive at a mean of 43.8 months after surgery, and without any recurrence. CONCLUSION: The risk factors for malignancy were found to be the polyp size and patient age. A laparoscopic cholecystectomy can be considered an adequate treatment for patients with a stage I gallbladder carcinoma.
Adenoma ; Adenomyoma ; Cholecystectomy, Laparoscopic* ; Cholesterol ; Diagnosis ; Gallbladder* ; Gallstones ; Humans ; Polyps ; Recurrence ; Retrospective Studies ; Risk Factors ; Ultrasonography

A uterus-like mass (ULM) is a central cavity lined by endometrial glands and stroma and surrounded by thick-walled smooth muscles. To date, 31 cases of ULM have been reported in the English literature. ULM typically presents as a single mass and is located in the pelvic cavity. We report here a very rare case of multiple extrapelvic ULMs involving the cecum, descending colon, and mesocolon. After extensive literature research, our case appears to be the first case of multiple ULMs found in extrapelvic sites and the first case of ULM in the colon. The present case suggests that ULM should be included in the differential diagnosis of colonic submucosal tumors in female patients with chronic abdominal pain or menstruation-associated symptoms.
Abdominal Pain ; Adenomyoma ; Cecum ; Colon ; Colon, Descending ; Diagnosis, Differential ; Female ; Humans ; Mesocolon ; Muscle, Smooth

BACKGROUND/AIMS: Ampullary tumors come in a wide variety of malignant forms. We evaluated the diagnostic accuracy of endoscopy for ampullary tumors, and analyzed the causes of misdiagnosis. METHODS: We compared endoscopic imaging and biopsy results to final diagnoses. Types of endoscope, numbers of biopsy specimens taken, and final diagnoses were evaluated as possible factors influencing diagnostic accuracy. RESULTS: Final diagnoses were 19 adenocarcinomas, 18 normal or papillitis, 11 adenomas, two adenomyomas, one paraganglioma, and one neuroendocrine tumor. The diagnostic accuracy of endoscopic imaging or the initial biopsy was identical (67.3%). At least one test was concordant with the final diagnosis in all except two cases. Compared with the final diagnosis, endoscopic imaging tended to show more advanced tumors, whereas the initial biopsy revealed less advanced lesions. The diagnostic accuracy of the initial biopsy was influenced by the type of endoscope used and the final diagnosis, but not by the number of biopsies taken. CONCLUSIONS: Endoscopy has limited accuracy in the diagnosis of ampullary tumors. However, most cases with concordant endoscopic imaging and biopsy results are identical to the final diagnosis. Therefore, in cases where both of these tests disagree, re-evaluation with a side-viewing endoscope after resolution of papillitis is required.
Adenocarcinoma ; Adenoma ; Adenomyoma ; Biopsy ; Diagnosis ; Diagnostic Errors ; Endoscopes ; Endoscopy* ; Neuroendocrine Tumors ; Papilledema ; Paraganglioma

Adenomyoma is a rare non-neoplastic lesion of the biliary tract. Here we report on three cases of adenomyoma; one located in the ampulla of Vater and two located in the common bile duct. Although preoperative endoscopic and radiological evaluations could not determine whether lesions were benign or malignant, intra-operative frozen section histologic examinations aided the differential diagnosis. Microscopic features of a lobular gland architecture with basally located nuclei and the absence of desmoplastic stromal reaction were found to be characteristic in frozen and paraffin sections.
Adenomyoma* ; Ampulla of Vater* ; Biliary Tract ; Common Bile Duct* ; Diagnosis, Differential ; Frozen Sections ; Paraffin

Atypical polypoid adenomyoma of the uterus is a rare tumor and usually occurs in young women. The most common symptom is abnomal uterine bleeding and the definite diagnosis of the lesions depends on microscopic features. The treatment of this tumor depends on the age of the patient, her desire to retain reproductive function, and the severity of her symptoms. If the patient desires to preserve her reproductive capacity, repeated dilatations and curettages must be done because of the possibility of coexisting endometrial carcinoma. If not, hysterectomy is acceptable. We experienced a rare case of atypical polypoid adenomyoma of the uterus in a postmenopausal woman and report it with brief review of literature.
Adenomyoma* ; Curettage ; Diagnosis ; Dilatation ; Endometrial Neoplasms ; Female ; Humans ; Hysterectomy ; Postmenopause ; Uterine Hemorrhage ; Uterus*

A heterotopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare. We describe the second case of adenocarcinoma arising in a gastric heterotopic pancreas of an asymptomatic 35-yr-old man in Korea. Esophagogastroduodenoscopy revealed a submucosal tumor with an irregular central umbilication in the gastric antrum. A wedge resection specimen demonstrated a submucosal oligolocular cystic mass (1.7x1.4x1.2 cm) with a solid portion. Microscopically, the cystic portion was composed of dilated pancreaticobiliary type ducts with adjacent small foci of periductal glandular structures. The adenocarcinoma components in the solid area infiltrated the proper muscle and the overlying mucosa of the stomach. The transitional area between the benign ductal structures and the adenocarcinoma component was found. The follow-up course was uneventful 5 months postoperatively.
Adenocarcinoma/complications/*diagnosis/pathology ; Adenomyoma/pathology ; Adult ; Autopsy ; Choristoma ; Epithelium/pathology ; Gastric Mucosa/pathology ; Human ; Male ; Pancreas/*abnormalities ; Pancreatic Neoplasms/complications/*diagnosis/pathology ; Time Factors

BACKGROUND/AIMS: The objective of our study was to identify useful computed tomography (CT) findings for differentiating fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder. METHODS: We retrospectively identified cases of 41 patients with pathologically proven adenomyomatosis (n=21) or chronic cholecystitis (n=20) who had fundal thickening of the gallbladder on preoperative abdominal CT. Analysis of the CT findings included evaluation of the thickness, contour, border, intralesional cystic area, adjacent gallbladder wall thickening, presence of inner layer enhancement, enhancement grade, enhancement pattern, and presence of stones. Statistical analyses were performed using the Mann-Whitney U test and Fisher exact test. RESULTS: Oval contour, inner layer enhancement and intralesional cystic area were more frequently noted in adenomyomatosis than in chronic cholecystitis (p<0.05 for each finding). Flat contour and adjacent gallbladder wall thickening were more frequently observed in chronic cholecystitis than in adenomyomatosis. No differences between adenomyomatosis and chronic cholecystitis in terms of the thickness, enhancement grade, enhancement pattern and presence of stones were apparent. CONCLUSIONS: CT may help to differentiate fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder.
Adenomyoma/*pathology/radiography ; Adult ; Aged ; Cholecystitis/*pathology/radiography ; Chronic Disease ; Diagnosis, Differential ; Female ; Gallbladder ; Gallbladder Neoplasms/*pathology/radiography ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed

Adenomyomatous hyperplasia is a reactive malformation or non-neoplastic tumor-like lesion frequently observed in the gallbladder, stomach, duodenum and jejunum, but rare in the extrahepatic bile duct. A 42-year-old man with epigastric discomfort had a stricture in the common bile duct on initial CT scans. Initially, it was regarded as a malignant lesion with some evidence, but histopathologic examinations of multiple biopsies obtained by multiple sessions of endoscopic retrograde cholangiopancreatography showed no evidence of malignancy. The patient had undergone the pylorus preserving pancreaticoduodenectomy because of the possibility of malignancy; however, the final diagnosis was adenomyomatous hyperplasia. It is important to distinguish a malignancy from benign biliary stricture with endoscopic biopsies. Surgery for suspected biliary malignancy often reveals benign lesions. Therefore, a correct diagnosis is important before deciding upon treatment of bile duct stricture. In conclusion, in younger patients with bile duct stricture where there is no evidence of histologic malignancy despite multiple biopsies, the possibility of benign disease such as adenomyomatous hyperplasia should be considered, to avoid unnecessary radical surgery.
Adenomyoma ; Adult ; Bile Ducts ; Bile Ducts, Extrahepatic ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms ; Common Bile Duct* ; Constriction, Pathologic* ; Diagnosis ; Duodenum ; Gallbladder ; Humans ; Hyperplasia* ; Jejunum ; Pancreaticoduodenectomy ; Pylorus ; Stomach ; Tomography, X-Ray Computed

PURPOSE: To evaluate the feasibility and efficacy of a laparoscopic wedge resection with hand-sewing closure in gastroduodenal tumors. METHODS: Laparoscopic wedge resections were performed in 16 patients with gastroduodenal tumors between May 2000 and December 2002 at Ewha Womans University Mok-Dong Hospital. Every case, with the exception of one, was performed via an extragastric approach, with a transgastric approach performed in the exception. Excision of lesion was performed manually using electrocautery and ultrasonic coagulating shears and closed by a manual (not use autosuture stapler) intracoporeal running suture. RESULTS: Of the 16 cases, two were performed with a laparoscope-assisted method, but there were no conversion to open surgery. Mean size of lesions was 27.9 mm in diameter and mean operation time was 219 minutes. In all cases, a complete tumor excision with negative surgical margins was obtained. The final pathologic diagnoses were: ectopic pancreas 4 cases, gastrointestinal stromal tumor 3 cases, leiomyoma 2 cases, adenomyoma 2 cases, tubular adenoma 1 case, Brunner's gland hyperplasia 1 case, carcinoid tumor 1 case, eosinophilic granuloma 1 case, and post endoscopic mucosectomy state for early gastric cancer 1 case. The average number of days to the first postoperative oral food intake and hospital stay were 3.1 and 6.0 days, respectively. There were no postoperative complications. CONCLUSION: A laparoscopic wedge resection with hand-sewing closure should be considered as a valid treatment option for selected gastroduodenal tumors, in terms of its feasibility, safety, and cost. A more efficient surgical instrument and technique should be developed in the future.
Adenoma ; Adenomyoma ; Carcinoid Tumor ; Conversion to Open Surgery ; Diagnosis ; Eating ; Electrocoagulation ; Eosinophilic Granuloma ; Female ; Gastrointestinal Stromal Tumors ; Humans ; Hyperplasia ; Leiomyoma ; Length of Stay ; Pancreas ; Postoperative Complications ; Running ; Stomach Neoplasms ; Surgical Instruments ; Sutures ; Ultrasonics