Atypical polypoid adenomyoma (APA) is an uncommon type of polypoid characterized by fibroid stroma and endometrial glands. It occurs mostly in premenopausal women and rarely in postmenopausal women with irregular vaginal bleeding. In our current case, a 76-year-old woman presented with irregular vaginal bleeding. The final pathological diagnosis of the mass was APA. APA is not easy to diagnose before surgery. On the one hand, there was no obvious particularity in imaging features and clinical features, especially for uncomfortably identifying endometrial cancer. On the other hand, APA has a pedicle, attaching to any part of the uterine cavity, which can cause pseudocoel between the mass with the uterine cavity wall. So, when it comes to getting the pathological tissue in the absence of hysteroscopy, it is easy to access to the pseudocoel and obtain endometrial tissue rather than the pathological tissue of the mass. Therefore, preoperative imaging examination is of great significance diagnosis way of thinking to clinicians for APA. In the meantime, pathological tissue of APA can be obtained by hysteroscopy in visual conditions.
Adenomyoma/pathology* ; Aged ; Female ; Humans ; Hysteroscopy ; Magnetic Resonance Imaging ; Pregnancy ; Uterine Hemorrhage ; Uterine Neoplasms/diagnostic imaging*

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

An adenomyoma is a rare, benign tumor, characteristically composed of a mixture of glandular structures with intervening bundles of smooth muscle. An adenomyoma is considered to be a variant of an ectopic pancreas, without exocrine or endocrine components. Adenomyomas of the gastrointestinal tract are found most frequently in the stomach and the small intestine is rarely involved. Gastric adenomyoma is frequently localized in the antrum or pylorus and very rarely occurs in the body. Adenomyomas often appear as a submucosal mass. A 48-year-old man was referred for further management of a 2.5-cm pedunculated polyp in the stomach. The resected tumor was diagnosed as an adenomyoma of the stomach. To the best of our knowledge, this is the first case reported in the literature of gastric adenomyoma that presented as a pedunculated polyp in the body and was treated completely with endoscopic resection.
Adenomyoma* ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Middle Aged ; Muscle, Smooth ; Pancreas ; Polyps* ; Pylorus ; Stomach*

Adenomyoma is a non-neoplastic lesion that frequently occurs in the gallbladder, but it's rarely found at the ampulla of Vater. When it develops at the ampulla of Vater, it may be mistaken for a periampullary malignancy. A 64-year-old asymptomatic male patient visited to our hospital with abnormal sonogram findings. Abdominal computed tomography and magnetic resonance cholangiopancreatography showed dilatations of common bile duct and main pancreatic duct. However, there was no definite ampullary mass. We performed endoscopic biopsies and endoscopic ultrasonography-guided fine needle aspiration. But the results were negative for malignant cells. Because we could not completely rule out malignancy, pylorus preserving pancreato-duodenectomy was performed. Histologically, hyperplastic components are intermixed with smooth muscle fibers in the subepithelial portion of ampulla of Vater. Awareness of adenomyoma of the ampulla of Vater is very important because of their clinical and endoscopic similarities to ampullary tumors.
Adenomyoma* ; Ampulla of Vater* ; Biopsy ; Biopsy, Fine-Needle ; Cholangiopancreatography, Magnetic Resonance ; Common Bile Duct ; Dilatation* ; Gallbladder ; Humans ; Male ; Middle Aged ; Muscle, Smooth ; Pancreatic Ducts* ; Pylorus

An adenomyomectomy is a conservative-surgical option for preserving fertility. Conventional laparoscopic adenomyomectomies present difficulties in adenomyoma removal and suturing of the remaining myometrium. Robot-assisted laparoscopic surgery could overcome the limitations of conventional laparoscopic surgery. Four patients with severe secondary dysmenorrhea and pelvic pain visited Seoul St. Mary's Hospital and were diagnosed with adenomyosis by pelvic ultrasonography and pelvic magnetic resonance imaging (MRI). The four patients were unmarried, nulliparous women, who desired a fertility-preserving treatment. We performed robot-assisted laparoscopic adenomyomectomies. The dysmenorrhea and pelvic pain of the patients nearly disappeared after surgery. No residual adenomyosis was observed on the follow-up pelvic MRI. A robot-assisted laparoscopic adenomyomectomy was feasible, and could be a minimally invasive surgical option for fertility-sparing treatment in patients with adenomyosis.
Adenomyoma ; Adenomyosis ; Animals ; Dysmenorrhea ; Female ; Fertility Preservation ; Fertility* ; Follow-Up Studies ; Humans ; Laparoscopy ; Magnetic Resonance Imaging ; Mice ; Minimally Invasive Surgical Procedures ; Myometrium ; Pelvic Pain ; Robotic Surgical Procedures ; Seoul ; Single Person ; Ultrasonography

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

We diagnosed a 2-cm, large cystic adenomyoma after complete abortion without transcervical curettage, based on symptoms of dysmenorrhea, time of onset, and sonographic findings. The cystic adenomyoma was treated successfully with laparoscopic mass excision.
Adenomyoma* ; Curettage* ; Dysmenorrhea ; Female ; Laparoscopy ; Ultrasonography ; Uterus*

OBJECTIVE: To compare the diagnostic performance of high-resolution ultrasound (HRUS) with contrast-enhanced CT and contrast-enhanced magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) to differentiate between adenomyomatosis (ADM) and gallbladder cancer (GBCA). MATERIALS AND METHODS: Forty patients with surgically proven ADM (n = 13) or GBCA at stage T2 or lower (n = 27) who previously underwent preoperative HRUS, contrast-enhanced CT, and contrast-enhanced MRI with MRCP were retrospectively included in this study. According to the well-known diagnostic criteria, two reviewers independently analyzed the images from each modality separately with a five-point confidence scale. The interobserver agreement was calculated using weighted kappa statistics. A receiver operating characteristic curve analysis was performed and the sensitivity, specificity, and accuracy were calculated for each modality when scores of 1 or 2 indicated ADM. RESULTS: The interobserver agreement between the two reviewers was good to excellent. The mean Az values for HRUS, multidetector CT (MDCT), and MRI were 0.959, 0.898, and 0.935, respectively, without any statistically significant differences between any of the modalities (p > 0.05). The mean sensitivity of MRI with MRCP (80.8%) was significantly higher than that of MDCT (50.0%) (p = 0.0215). However, the mean sensitivity of MRI with MRCP (80.8%) was not significantly different from that of HRUS (73.1%) (p > 0.05). The mean specificities and accuracies among the three modalities were not significantly different (p > 0.05). CONCLUSION: High-resolution ultrasound and MRI with MRCP have comparable sensitivity and accuracy and MDCT has the lowest sensitivity and accuracy for the differentiation of ADM and GBCA.
Adenomyoma/*diagnosis ; Adult ; Aged ; Aged, 80 and over ; Cholangiopancreatography, Magnetic Resonance/methods ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Diagnostic Imaging/*methods ; Female ; Gallbladder Neoplasms/*diagnosis ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Observer Variation ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/methods ; Ultrasonography/methods

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

Adenocarcinoma ; pathology ; Adenomatoid Tumor ; metabolism ; pathology ; surgery ; Adenomyoma ; pathology ; Adult ; Antibodies, Monoclonal, Murine-Derived ; metabolism ; Biomarkers, Tumor ; metabolism ; Calbindin 2 ; metabolism ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Keratins ; metabolism ; Leiomyoma ; pathology ; Lymphatic Vessel Tumors ; metabolism ; pathology ; Middle Aged ; Uterine Neoplasms ; metabolism ; pathology ; surgery ; Young Adult