RESUMEN
BACKGROUND: Gastric adenomyoma is a rare benign tumor composed of glandular structures and smooth muscle fibers. While some classify gastric adenomyoma as a hamartoma, others view it as an abortive form of heterotopic pancreas. Despite its benign nature, there is a risk of malignant transformation. Predominantly found in the antrum, gastric adenomyoma affects all ages but is most common in adults aged 40-60 years. Symptoms are nonspecific, and its similarity to other lesions complicates diagnosis. This paper aims to provide a review of medical literature on gastric adenomyoma and its diagnosis and treatment methods, along with presenting an additional case report on the same topic. CASE PRESENTATION: We present the case of a 55-year-old Syrian man who experienced vomiting, weight loss, and chronic partial constipation. An obstructing mass in the pylorus was detected, and then an open surgery was performed to excise the lesion. A biopsy of the resected mass was obtained for histopathological examination. The final diagnosis of the lesion was pyloric-region adenomyoma with severe pyloric stenosis. After the successful surgery, the patient recovered without any recurrence or complications. CONCLUSIONS: Several diagnostic approaches are available, including radiological studies, endoscopic examination, and fine needle aspiration guided by endoscopic ultrasonography. Treatment options involve endoscopic submucosal dissection and complete laparotomy resection. Further studies and thorough reviews are recommended to better understand the best clinical practices. Practitioners should consider gastric adenomyoma when encountering a mural gastric lesion.
Asunto(s)
Adenomioma , Obstrucción de la Salida Gástrica , Neoplasias Gástricas , Humanos , Masculino , Persona de Mediana Edad , Adenomioma/patología , Adenomioma/cirugía , Adenomioma/complicaciones , Adenomioma/diagnóstico por imagen , Obstrucción de la Salida Gástrica/etiología , Obstrucción de la Salida Gástrica/cirugía , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugía , Píloro/patología , Píloro/cirugía , Vómitos/etiología , Resultado del TratamientoRESUMEN
RATIONALE: Uterine adenomyomas (UAs) are common benign tumors, usually not exceeding 280 g or the weight of the uterus at 12 weeks gestation. Postmenopausal giant UAs of diameter larger than 20 cm are rare, as well as steatosis, but curable by surgical excision. Few cases of postmenopausal giant UAs have been reported. PATIENT CONCERNS: Herein, we report a case of a 70-year-old female patient who presented with a giant pelvic tumor of about 20 cmâ ×â 18 cmâ ×â 20 cm with postmenopausal vaginal bleeding, and whose radiographic manifestations did not exclude the possibility of uterine malignancy. DIAGNOSES: Histopathology confirms an adenomyoma with partial adipose metaplasia. INTERVENTIONS: We did an open laparotomy of hysterectomy, bi-adnexectomy, and pelvic adhesion release for the patient. OUTCOMES: Pathology revealed adenomyoma with adipose metaplasia. The patient recovered well and was discharged on postoperative day 7 with satisfactory follow-up.
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Adenomioma , Metaplasia , Posmenopausia , Neoplasias Uterinas , Humanos , Femenino , Anciano , Adenomioma/patología , Adenomioma/cirugía , Adenomioma/diagnóstico por imagen , Metaplasia/patología , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugía , Tejido Adiposo/patología , HisterectomíaRESUMEN
Pelvic masses frequently originate from the pelvic cavity and are often associated with uterine, ovarian, or intestinal disorders. This report describes the case of a patient with a pelvic mass diagnosed as a retroperitoneal dermoid cyst at our hospital. We analyzed this case and conducted a literature review, to mitigate the risk of misdiagnosis and enhance the treatment of retroperitoneal masses.
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Adenomioma , Quiste Dermoide , Neoplasias Retroperitoneales , Neoplasias Uterinas , Humanos , Femenino , Quiste Dermoide/cirugía , Quiste Dermoide/complicaciones , Quiste Dermoide/diagnóstico , Quiste Dermoide/patología , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/complicaciones , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Retroperitoneales/cirugía , Neoplasias Uterinas/patología , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirugía , Neoplasias Uterinas/diagnóstico por imagen , Adenomioma/patología , Adenomioma/cirugía , Adenomioma/complicaciones , Adenomioma/diagnóstico , Adenomioma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , AdultoRESUMEN
We report a case of alpha-fetoprotein-producing endometrioid carcinoma (AFP-EC) that originated within an adenomyoma of the uterine corpus. A 76-year-old Japanese woman was incidentally discovered to have a uterine tumor along with multiple lung nodules. Upon surgical removal of the uterus, it was revealed that the tumor was situated within the adenomyoma. The tumor exhibited microfollicular structures and solid growth patterns, with hyaline globules, clear cell glands, and primitive tumor cells. Immunohistochemical analysis indicated the presence of germ cell markers, including AFP, SALL4, and glypican3, leading to final diagnosis of AFP-EC. Histopathologically, AFP-ECs exhibit characteristics similar to those of AFP-producing neoplasms in other organs. Furthermore, a nomenclature issue arises when distinguishing AFP-ECs from yolk sac tumors of the endometrium in older patients due to their shared features. The concept of retrodifferentiation or neometaplasia suggests that "endometrioid carcinoma with yolk sac tumor differentiation" or "endometrioid carcinoma with a primitive phenotype" may serve as more fitting terms for the diverse spectrum of AFP-producing neoplasms in the endometrium. In conclusion, this case underscores the diagnostic challenges posed by AFP-ECs arising from adenomyomas and emphasizes the need for refining the nomenclature and classification of AFP-producing neoplasms within the endometrium.
Asunto(s)
Adenomioma , Carcinoma Endometrioide , alfa-Fetoproteínas , Humanos , Femenino , Carcinoma Endometrioide/patología , Carcinoma Endometrioide/metabolismo , Carcinoma Endometrioide/diagnóstico , Carcinoma Endometrioide/cirugía , Anciano , alfa-Fetoproteínas/metabolismo , Adenomioma/patología , Adenomioma/metabolismo , Adenomioma/diagnóstico , Neoplasias Uterinas/patología , Neoplasias Uterinas/metabolismo , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirugía , Glipicanos/metabolismo , Biomarcadores de Tumor/metabolismo , Inmunohistoquímica , Neoplasias Endometriales/patología , Neoplasias Endometriales/metabolismo , Neoplasias Endometriales/diagnóstico , Factores de Transcripción/metabolismoRESUMEN
OBJECTIVE: To assess the efficacy and safety of percutaneous image-guided cryoablation of adenomyomas MATERIAL AND METHODS: Five symptomatic women who wanted to preserve their uterus and fertility underwent a single session of percutaneous image-guided cryoablation of adenomyoma. Three to six 17-gauge cryoprobes were introduced percutaneously into the adenomyoma under ultrasound and laparoscopy guidance. Clinical efficacy was defined as the diminution of the Visual Analogue Scale of pain (VAS), the decrease in uterine bleeding and the improvement of quality of life assessed by the endometriosis health profile 5 (EHP-5) 12 months after treatment. Technical efficacy was defined by the reduction in volume of each treated adenomyoma on MRI. Complications were classified using the Clavien-Dindo classification system. Hysterosonography was performed at least 3 months after the procedure. RESULTS: Compared to the baseline, all symptom scores had decreased after 12 months: median VAS 8/10 (range, 5-10) to 4/10 (range, 0-7); median dyspareunia score 7/10 (range, 0-10) to 2/10 (range, 0-8); median bleeding score 335 (range, 102-920) to 76 (range, 0-88); median EHP-5 score 60/100 (range, 50-75) to 50/100 (range, 32-55). The median volume of adenomyosis decreased from 57 cm3 (range, 8-87) to 9 cm3 (range, 2-45) at 12 months. No postoperative complications occurred. Two patients had incomplete intrauterine adhesions that were easily removed hysteroscopically. CONCLUSION: Cryoablation may be a promising alternative treatment for symptomatic adenomyoma in women who want to preserve their uterus.
Asunto(s)
Adenomioma , Criocirugía , Endometriosis , Enfermedades Uterinas , Humanos , Femenino , Adenomioma/diagnóstico por imagen , Adenomioma/cirugía , Calidad de Vida , Útero , DolorRESUMEN
OBJECTIVE: To describe a case of extrauterine adenomyoma (EA) and review all the cases of EA in the literature. METHODS: Pubmed/MEDLINE, Embase, and Google Scholar from 1807 to December 2022. All studies reporting the histologic diagnosis of an EA. We collected the following data: patient's age, size and location of adenomyoma, presence of endometriosis and adenomyosis, past gynecologic treatment, symptoms, diagnostic imaging, surgical intervention, alternative/adjuvant treatment, associated malignancy, and follow up. RESULTS: Sixty-seven studies with 85 patients were included. Pain was the most frequent symptom (69.5%). Among diagnostic examinations, ultrasonography was used in 60 out of 81 reported cases, with several radiologic features described. EA was located inside the pelvis in 77.6% of patients. Adnexa were the most frequent site of the disease (24, 28.2%). History of endometriosis or adenomyosis was described in 35 patients (35, 41.2%). Uterine tissue morcellation was reported in 6 of the 85 patients (7.1%). Associated malignancy was detected in 9 out of 85 patients with available data (10.6%). There were two recurrences of disease. CONCLUSION: Specific imaging features of EA are yet to be described in the literature. History of endometriosis and adenomyosis or uterine tissue morcellation may be suggestive of EA. Histologic examination can give a definitive diagnosis and exclude malignant transformation.
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Adenomioma , Adenomiosis , Endometriosis , Neoplasias Uterinas , Humanos , Femenino , Endometriosis/complicaciones , Endometriosis/diagnóstico , Endometriosis/cirugía , Adenomiosis/diagnóstico por imagen , Adenomiosis/cirugía , Adenomioma/diagnóstico , Adenomioma/cirugía , Útero/cirugía , Pelvis , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/cirugíaRESUMEN
Although heterotopic pancreas usually occurs in the stomach and rarely presents as a submucosal tumor, an accurate preoperative diagnosis is often difficult because of the variety of clinical symptoms and findings depending on the size and location of the lesion. We experienced a case of gastric type III heterotopic pancreas presenting as a gastric adenomyoma in the antrum of the stomach. A 62-year-old woman visited a local hospital for epigastric discomfort. An esophagogastroduodenoscopy study indicated a submucosal tumor in the greater curvature of the gastric antrum. The patient underwent surgical resection of the tumor because it was enlarged. The histological sections of the resected specimen showed that the tumor was composed of ductular structures lined by tall columnar epithelia and a prominent smooth muscle stroma with no atypical cells. The tumor was compatible with Heinrich's type III heterotopic pancreas, which presented as an adenomyoma of the stomach. These findings provide useful histological features and some insight into a better understanding of the embryonic origin and development of adenomyoma and heterotopic pancreas in the antrum of the stomach.
Asunto(s)
Adenomioma , Coristoma , Neoplasias Gástricas , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Gástricas/patología , Adenomioma/diagnóstico por imagen , Adenomioma/cirugía , Adenomioma/patología , Coristoma/patología , Páncreas/patologíaRESUMEN
CONTEXT.: The nature and associations of gallbladder (GB) "adenomyoma" (AM) remain controversial. Some studies have attributed up to 26% of GB carcinoma to AMs. OBJECTIVE.: To examine the true frequency, clinicopathologic characteristics, and neoplastic changes in GB AM. DESIGN.: Cholecystectomy cohorts analyzed were 1953 consecutive cases, prospectively with specific attention to AM; 2347 consecutive archival cases; 203 totally embedded GBs; 207 GBs with carcinoma; and archival search of institutions for all cases diagnosed as AM. RESULTS.: Frequency of AM was 9.3% (19 of 203) in totally submitted cases but 3.3% (77 of 2347) in routinely sampled archival tissue. A total of 283 AMs were identified, with a female to male ratio = 1.9 (177:94) and mean size = 1.3 cm (range, 0.3-5.9). Most (96%, 203 of 210) were fundic, with formed nodular trabeculated submucosal thickening, and were difficult to appreciate from the mucosal surface. Four of 257 were multifocal (1.6%), and 3 of 257 (1.2%) were extensive ("adenomyomatosis"). Dilated glands (up to 14 mm), often radially converging to a point in the mucosa, were typical. Muscle was often minimal, confined to the upper segment. Nine of 225 (4%) revealed features of a duplication. No specific associations with inflammation, cholesterolosis, intestinal metaplasia, or thickening of the uninvolved GB wall were identified. Neoplastic change arising in AM was seen in 9.9% (28 of 283). Sixteen of 283 (5.6%) had mural intracholecystic neoplasm; 7 of 283 (2.5%) had flat-type high-grade dysplasia/carcinoma in situ. Thirteen of 283 cases had both AM and invasive carcinoma (4.6%), but in only 5 of 283 (1.8%), carcinoma arose from AM (invasion was confined to AM, and dysplasia was predominantly in AM). CONCLUSIONS.: AMs have all the features of a malformative developmental lesion, and may not show a significant muscle component (ie, the name "adeno-myoma" is partly a misnomer). While most are innocuous, some pathologies may arise in AMs, including intracholecystic neoplasms, flat-type high-grade dysplasia or carcinoma in situ, and invasive carcinoma (1.8%, 5 of 283). It is recommended that gross examination of GBs include serial slicing of the fundus for AM detection and total submission if one is found.
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Adenomioma , Carcinoma in Situ , Carcinoma , Neoplasias de la Vesícula Biliar , Humanos , Masculino , Femenino , Vesícula Biliar/patología , Adenomioma/diagnóstico , Adenomioma/patología , Carcinoma/patología , Neoplasias de la Vesícula Biliar/patología , Carcinoma in Situ/patología , Hiperplasia/patologíaRESUMEN
Radiologists across many imaging modalities commonly encounter gallbladder adenomyomatosis. The classic imaging appearances of gallbladder adenomyomatosis are well described and confirm benignity. However, in clinical practice, adenomyomatosis can be challenging to differentiate from other gallbladder pathologies that require cholecystectomy. In this article, we describe the common and uncommon appearances of gallbladder adenomyomatosis on multimodality imaging, helping differentiate adenomyomatosis from non-benign gallbladder abnormalities. Accurately differentiating adenomyomatosis from its mimics provides the surgical team with important clinical and surgical management information, improving patient outcomes.
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Adenomioma , Enfermedades de la Vesícula Biliar , Neoplasias de la Vesícula Biliar , Humanos , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/patología , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/patología , Adenomioma/diagnóstico por imagen , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Imagen MultimodalRESUMEN
BACKGROUND Intussusception is a frequent abdominal emergency in infancy, requiring immediate diagnosis and therapeutic intervention. In approximately 90% of cases, intussusception seems to be idiopathic. There has been a reported association of intussusception with lymphoid hyperplasia of Peyer patches in the terminal ileum, possibly acting as the triggering factor. Clinical presentation varies substantially, while the etiology seems idiopathic in most reported cases. CASE REPORT This case describes a previously healthy 2-month-old girl who presented with an episode of non-bilious vomiting and deterioration during the 12 hours preceding the visit. Abdominal ultrasonography revealed the typical target sign in the right iliac fossa, without visible peristalsis, confirming the diagnosis of intussusception. Failure of non-surgical reduction led to emergency laparotomy with the working diagnosis of intussusception due to Meckel's diverticulum. However, laparotomy instead revealed an adenomyoma of the small intestine, a rare benign tumor-like lesion, as the pathological lead point. CONCLUSIONS This case is interesting for 2 distinct reasons. Not only does it underline the need to maintain a high index of suspicion for triggering factors, even in patients within atypically affected age groups, but it also adds to the remarkably limited selection of reported adenomyomas of the small intestine acting as the pathological lead point for intussusception. In this case report, we aspire to emphasize that especially in patients outside the most affected age group, pediatric surgeons should remain aware of the possibility of adenomyoma as a pathological lead point.
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Adenomioma , Intususcepción , Divertículo Ileal , Femenino , Humanos , Lactante , Adenomioma/complicaciones , Adenomioma/cirugía , Íleon/cirugía , Intususcepción/diagnóstico , Laparotomía , Divertículo Ileal/cirugíaRESUMEN
RATIONALE: Adenomyosis, a gynecological condition characterized by endometrial tissue within the uterine myometrium, often leads to menstrual pain and heavy bleeding, significantly affecting the quality of life. The primary treatment for adenomyosis and leiomyomas is hysterectomy. However, in rare instances, these conditions can recur in the cervical stump following a hysterectomy.Here, we present a case of cervical adenomyoma development after a prior laparoscopic supracervical hysterectomy. PATIENT CONCERNS: A 47-year-old woman sought medical attention due to increased vaginal bleeding. DIAGNOSES: She had undergone a laparoscopic supracervical hysterectomy 7 years earlier to address uterine myoma and adenomyosis. Just 1 month posthysterectomy, a pelvic ultrasound revealed the presence of a cervical stump measuring approximately 4.0 × 4.0 cm. Subsequent follow-up ultrasounds documented the gradual growth of the cervical mass. Two years ago, a recurrent myoma was identified, and the patient experienced intermittent vaginal bleeding. Over 7 years, the cervical mass increased from 4 to 7 cm. Preadmission pelvic ultrasonography confirmed the existence of cervical adenomyoma measuring 7 × 6 cm. INTERVENTIONS: Consequently, the patient underwent a laparoscopic trachelectomy. Intraoperatively, an enlarged cervix, approximately 7 × 6 cm in size, containing adenomyoma was observed. A gross examination of the specimen indicated hypertrophic muscle tissue and hemorrhagic foci. Subsequent histopathological examination confirmed the presence of adenomyoma. OUTCOMES: Remarkably, the patient exhibited no recurrence over the subsequent 8 months. LESSONS: The case presented here highlights the potential occurrence of cervical adenomyoma following a supracervical hysterectomy. Management options include hormone therapy and surgical excision. Furthermore, annual follow-up comprising ultrasound and pap smear evaluations is recommended for patients with supracervical hysterectomies to detect and address possible recurrences.
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Adenomioma , Adenomiosis , Laparoscopía , Leiomioma , Mioma , Neoplasias del Cuello Uterino , Femenino , Humanos , Persona de Mediana Edad , Adenomiosis/cirugía , Adenomioma/cirugía , Calidad de Vida , Histerectomía , Leiomioma/cirugía , Hemorragia Uterina/cirugía , Neoplasias del Cuello Uterino/cirugíaRESUMEN
AIM: Adenomyoma is an exceptionally rare hamartoma in the small intestine. Few data have been reported on the features of this rare disease. The aim of this study was to describe the ultrasound (US) characteristics of small intestinal adenomyomas. Material and methods: This retrospective study analyzed the clinical features and US data of 15 pediatric patients diagnosed as small intestinal adenomyomas in the age range between 1 day to 12 years in our hospital during 2014-2021. RESULTS: The clinical manifestations of all the small intestinal adenomyomas were abdominal pain, vomiting or/and hemafecia. The small intestinal adenomyoma usually acted as the lead point of secondary intussusception. They were identified in the ileum (n=11), jejunum (n=2), and Meckel's diverticulum (n=2). The diagnostic accuracy (the concordance rate between US diagnosis and pathological diagnosis) of small intestinal adenomyoma was 73.3%. The small intestinal adenomyoma had approximately 1.0-3.0 cm, were typically located in the submucosal region, had the basal part wide and without a pedicle, and its boundaries were clear. The mass protruded into the intestinal cavity, and showed oval hypoechoic polycystic echo nodules, containing multiple small quasi-circular or irregular cysts of different sizes surrounded by solid hypoechoic mosaic areas. The color Doppler US showed in the solid hypoechoic areas of the mass abundant or sparse blood flow signals.Conclusions The US findings of small intestinal adenomyomas in children are characteristic, and US is valuable in the identification of intestinal adenomyomas in children.
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Adenomioma , Divertículo Ileal , Humanos , Niño , Recién Nacido , Adenomioma/diagnóstico por imagen , Adenomioma/complicaciones , Adenomioma/patología , Estudios Retrospectivos , Divertículo Ileal/complicaciones , Ultrasonografía , Ultrasonografía Doppler en ColorRESUMEN
BACKGROUND: Adenomyoma of the small intestine is rare in children and the clinical characteristics is not clear. The study was to document the clinical characteristics and treatment of children with adenomyoma of the small intestine. METHODS: A retrospective study was conducted in children with intestinal adenomyoma from 2010 to 2022. We recorded age, gender, symptoms, location, tumour size and treatment options. RESULTS: Thirteen patients with adenomyoma of the small bowel were included. The median age was 20 months with a male-to-female ratio of 10:3 and more than half of the patients were younger than 2 years old. The mean tumour size was 2.0 cm. The lesion was found accidentally in one patient, and the others presented with symptoms of intussusception. A pathological lead point was found on ultrasound in seven patients. All tumours were located in the ileum, ranging from 24 to 260 cm proximal to the ileocecal valve. The tumour was found in an antimesenteric site in eight patients. Three patients suffered intestinal necrosis, and segmental resection of the ileum was performed. Three patients without intestinal necrosis underwent tumour rection, while intestinal resection and anastomosis were performed in the remaining seven. All patients recovered well except one, who developed intussusception 7 days after surgery; that patient underwent surgery and recovered uneventfully. CONCLUSIONS: Adenomyoma of the small intestine has a male predominance in children and intussusception is a common presentation. The ultrasound feature is a mass of mixed echogenicity containing several small cystic areas. Surgery is the primary treatment option and the procedure should be chosen based on intraoperative findings.
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Adenomioma , Enfermedades Intestinales , Intususcepción , Humanos , Masculino , Niño , Femenino , Lactante , Preescolar , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Estudios Retrospectivos , Adenomioma/diagnóstico , Adenomioma/patología , Adenomioma/cirugía , Centros de Atención Terciaria , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/cirugía , Intestino Delgado/patología , NecrosisRESUMEN
PURPOSE: To investigate clinicopathological differences between typical endometrial polypoid adenomyomas (TPAs) and endometrial polyps (EPs) and to determine the risk factors and recurrence of TPA and further clarify the pathogenesis and treatment of TPA. METHODS: We reviewed the medical records of 488 women with TPA and 500 women with EP. Then, we analyzed the clinical features and manifestations, ultrasonic manifestations, hysteroscopic morphology, and pathological results. In addition, 360 cases of TPA and 367 cases of EP were followed up for 22-77 months and the risk factors TPA recurrence were assessed. RESULTS: We detected significant differences in age, menopausal status, body mass index (BMI), the number of pregnancies, and parity between the two groups (P < 0.05). Hysteroscopy revealed that the incidence of polyps > 3 cm in diameter and multiple polyps in the TPA group was significantly higher than that in the EP group (P < 0.01). In addition, the rate of recurrence in the TPA group was significantly higher than that in the EP group (P < 0.05). Over three pregnancies, menopause, curettage, and the application of polyp clamps were all identified as independent risk factors for the recurrence of TPA (P < 0.05). CONCLUSION: In addition to high estrogen levels, endometrial injury was identified as the main contributor to TPA pathogenesis. Hysteroscopic electrotomy was identified as the preferential treatment for TPA to avoid recurrence, especially in women with risk factors. Increasing the depth of ablation may prevent the recurrence of TPA more efficiently.
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Adenomioma , Neoplasias Colorrectales , Femenino , Humanos , Embarazo , Adenomioma/cirugía , Índice de Masa Corporal , Estudios de Casos y Controles , Tamaño de la MuestraRESUMEN
RATIONALE: Adenomyoma is a rare reactive, hamartomatous benign tumor-like lesion. Although adenomyoma can occur anywhere in the gastrointestinal tract, including the gallbladder, stomach, duodenum, and jejunum, it is very rarely observed in the extrahepatic bile duct and ampulla of Vater (AOV). The preoperative accurate diagnosis of adenomyoma of the Vaterian system, including the AOV and common bile duct, is significant to appropriate patient management. However, discriminating between benign and malignancy is highly challenging. Patients are frequently mistaken as having periampullary malignancy, thereby leading to unnecessary extensive surgical resection with a high risk of complications. PATIENT CONCERNS: A 47-year-old woman visited a local hospital owing to epigastric and right upper-quadrant abdominal pain for 2 days. DIAGNOSES: Abdominal ultrasonography performed in the local hospital revealed suspicious of a distal common bile duct malignancy. She was transferred to our hospital for further evaluation and management. INTERVENTIONS: After consulting with the patient, a multidisciplinary team, including a gastroenterologist, finally decided to perform surgery under the impression of an ampullary malignancy, and pylorus-preserving pancreatoduodenectomy was performed without any complications. She was histopathologically diagnosed with an adenomyoma of the AOV. OUTCOMES: At the 5-year follow-up, she was well and did not develop further symptoms or complications. LESSONS: Although adenomyoma is very rare, it should be included in the differential diagnosis of mass-like lesions of the AOV to avoid unnecessary surgeries.
Asunto(s)
Adenomioma , Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco , Femenino , Humanos , Persona de Mediana Edad , Ampolla Hepatopancreática/cirugía , Ampolla Hepatopancreática/patología , Adenomioma/diagnóstico por imagen , Adenomioma/cirugía , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/cirugía , Neoplasias del Conducto Colédoco/patología , Conducto Colédoco/patología , PancreaticoduodenectomíaRESUMEN
Atypical polypoid adenomyoma is a rare benign tumor of the uterus that usually affects women of reproductive age and has an increased risk of progression into endometrial cancer. The pathogenetic mechanism has not been completely clarified. Due to the rarity of the tumor, current experience regarding the diagnostic and therapeutic approach is limited. For menopausal patients, hysterectomy seems to be the main treatment option. Our case concerns an asymptomatic menopausal patient with a vaginal delivery in her obstetric history and no hereditary history of gynecological cancer who came to the outpatient clinic for a gynecological examination. Transvaginal ultrasound revealed the presence of a large, round solid mass with increased vascularity within the endometrial cavity. A diagnostic dilation and curettage of the endometrium was performed. Histological examination of the endometrial biopsy showed an atypical polypoid adenomyoma, and it was decided to perform a total abdominal hysterectomy with bilateral adnexectomy. Histological examination of the surgical specimen of the uterus revealed no residual disease, no coexisting foci of atypical endometrial hyperplasia or endometrial cancer. The postoperative course was uneventful. The patient remains to this day under regular follow-up. The present case report highlights the significant difficulties involved in the preoperative diagnosis of atypical polypoid adenomyoma of the uterus and the difficult differential diagnosis from atypical endometrial hyperplasia and endometrial cancer, particularly in menopausal patients. At the same time, it is pointed out that despite its rarity, the early diagnosis of atypical polypoid adenomyoma, especially in young women, must be the main concern of the modern gynaecologist, in order to design the optimal treatment aimed at preserving fertility while avoiding the risk of recurrence of damage or malignant progression into endometrial cancer.
Asunto(s)
Adenomioma , Hiperplasia Endometrial , Neoplasias Endometriales , Neoplasias Uterinas , Humanos , Embarazo , Femenino , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirugía , Neoplasias Uterinas/patología , Hiperplasia Endometrial/patología , Adenomioma/diagnóstico , Adenomioma/cirugía , Adenomioma/patología , Neoplasias Endometriales/diagnóstico , Neoplasias Endometriales/cirugía , Neoplasias Endometriales/patología , Endometrio/cirugía , Endometrio/patología , MenopausiaRESUMEN
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a condition caused by Müllerian anomalies, is characterised by congenital vaginal aplasia and a rudimentary uterus. Case reports concerning uterine fibroids associated with MRKH syndrome are limited, and differentiating between uterine fibroids and ovarian solid tumours prior to surgical intervention is often challenging. Here, we present the case of a patient with MRKH syndrome and asymptomatic bilateral pelvic solid tumours located close to both ovaries. Based on intraoperative and histopathological findings, the tumours were diagnosed as adenomyomas of the rudimentary uterus. This is the first reported case of a uterine adenomyoma associated with MRKH syndrome. Moreover, our report highlights the fact that diagnostic laparoscopy is a valuable method to evaluate pelvic tumours in MRKH syndrome.
Asunto(s)
Trastornos del Desarrollo Sexual 46, XX , Adenomioma , Anomalías Congénitas , Laparoscopía , Leiomioma , Neoplasias Pélvicas , Femenino , Humanos , Adenomioma/complicaciones , Adenomioma/diagnóstico , Adenomioma/cirugía , Neoplasias Pélvicas/cirugía , Útero/cirugía , Útero/anomalías , Trastornos del Desarrollo Sexual 46, XX/complicaciones , Trastornos del Desarrollo Sexual 46, XX/diagnóstico , Trastornos del Desarrollo Sexual 46, XX/cirugía , Vagina/cirugía , Vagina/anomalías , Conductos Paramesonéfricos/cirugía , Conductos Paramesonéfricos/anomalías , Laparoscopía/métodos , Leiomioma/cirugía , Anomalías Congénitas/diagnóstico , Anomalías Congénitas/cirugíaRESUMEN
Endometrioid carcinoma with histopathologic resemblance to cutaneous pilomatrix carcinoma with mutations in the gene encoding beta-catenin, CTNNB1 are rare. There are minimal numbers of reports of high-grade tumors with this divergent differentiation in the literature. We report the case of a 29-yr-old female with an unusual presentation of endometrial cancer with overall histologic appearance indicative of a recently reported aggressive subtype of Federation of Gynecology and Obstetrics (FIGO) IVB grade 3 endometrioid carcinoma with features resembling cutaneous pilomatrix carcinoma. She was treated with a primary chemotherapy regimen with an initial significant response to treatment before developing symptomatic brain metastasis for which she underwent whole-brain radiotherapy. We discuss the unusual histologic and radiologic presentation as well as her individual management throughout this case report. The apparent association with morular metaplasia and atypical polypoid adenomyoma suggests that this rare carcinoma is within a spectrum of lesions associated with aberrant beta-catenin expression/beta-catenin mutation. Its aggressive nature highlights the importance of early recognition of this rare lesion.
Asunto(s)
Adenomioma , Neoplasias Óseas , Neoplasias de la Mama , Carcinoma Endometrioide , Femenino , Humanos , Embarazo , Adenomioma/diagnóstico , Adenomioma/genética , beta Catenina/genética , Carcinoma Endometrioide/diagnóstico , Carcinoma Endometrioide/genética , AdultoRESUMEN
A 55-year-old female patient with a history of ethyl and nicotine abuse presented with chronic diarrhoea, significant weight loss and abnormal liver tests. Ultrasound examination revealed dilatation of the bile ducts and computed tomography scan with IV contrast further established simultaneous dilatation of the common bile duct and pancreatic duct (double duct sign). The dilatation abruptly stopped at the level of the pancreatic head which demonstrated a small irregular hypovascular zone (1.2 cm), suspected for malignancy. The following week, a radical pancreaticoduodenectomy was performed. Anatomopathological analysis revealed an adenomyoma (12 mm) located distal to the common bile duct, without arguments for malignancy.