Bile tract adenomyoma: A case report

Adenomyomatosis of distal common bile duct: A case report and systemic review

RATIONALE

Adenomyomatosis is a rare benign condition characterized by epithelial proliferation and diverticular formation in the gastrointestinal tract, most commonly affecting the gallbladder. Its occurrence in the bile duct is uncommon but significant, as it can cause biliary obstruction, cholestasis, and abdominal pain-symptoms that closely mimic early-stage cholangiocarcinoma. This overlap creates diagnostic challenges and increases the risk of misdiagnosis and overtreatment, making accurate identification essential.

PATIENT CONCERNS

A 54-year-old woman presented with persistent epigastric dull pain. Imaging studies revealed a dilated common bile duct (CBD), raising concerns about biliary pathology.

DIAGNOSES

Abdominal computed tomography demonstrated a contrast-enhanced 1.6 cm tumor-like mass in the distal CBD, leading to a presumptive diagnosis of malignancy. Laboratory findings showed an elevated γ-glutamyl transferase level, while other tumor markers were within normal ranges.

INTERVENTIONS

Due to the high suspicion of malignancy, the patient underwent a Whipple procedure for both diagnostic and therapeutic purposes.

OUTCOMES

Histological examination of the resected specimen surprisingly revealed adenomyomatosis of the CBD, confirming a benign diagnosis. The patient had an uneventful postoperative recovery and was discharged 19 days after surgery.

LESSONS

This case highlights the diagnostic challenge posed by adenomyomatosis of the distal CBD, as its radiological appearance can closely resemble malignancy. Clinicians should be aware of this rare entity to avoid unnecessary aggressive surgical interventions.

Bile ductal mucosal dysplasia is a possible risk factor for adenocarcinoma in patients with adenomyomatous hyperplasia of the Vaterian system: a single-centre study from China

BACKGROUND

The relationship between adenomyomatous hyperplasia of the Vaterian system(AV) and cancer is unclear, some reports suggest that AV is often combined with mucosal glandular dysplasia, but it is not clear whether mucosal glandular dysplasia is a risk factor for carcinogenesis of AV. The aim of this study was to retrospective analysis of role of ductal glandular dysplasia as a risk factor in the development of carcinoma in AV.

METHODS

A total of 328 cases who underwent surgery with a final pathological diagnosis of adenomyomatous hyperplasia (AH) in the Chinese PLA General Hospital in BeiJing, China, between January 2005 and December 2021 were retrospectively collected. There were Seventeen cases(5%) in which the lesions were located in the common bile duct as well as the ampulla of Vater, and their clinical (age, sex, etc.), imaging (cholelithiasis, etc.) and pathological data (mucosal glandular dysplasia, etc.) were collected. Clinical data and pathological features of AV with or without mucosal glandular dysplasia were analyzed.

RESULTS

There were 17 out of 328 cases of AH occurring in the Vaterian system (5%). Three of seventeen AV cases were associated with carcinoma (18%). Of three cases, two (12%) with the tumor lesions in the mucosal glands adjacent to the AH (biliary tract cancer and ampullary cancer), and one (6%) with carcinoma developed from AH itself in the ampulla of Vater. All carcinomas had adenomyomatous hyperplasia with nearby mucosal glandular dysplasia (MGD). The percentage of BTC or AC was higher in patients with concurrent AH and MGD compared to AH patients without MGD. The results show tendency toward statistical significance (P = 0.082). This difference was more obvious among AH with severe dysplasia compared to adenomyomatous hyperplasia with mild-moderate dysplasia (P = 0.018).

CONCLUSION

This study is the first to find that AV is associated with biliary tract cancer and ampullary cancer. In AV, the mucosal glandular dysplasia may be a risk factor for the development of malignancy. The underlying mechanism for carcinogenesis of AV could be AH itself or its secretions stimulating mucosal glands hyperplasia, then mucosal glands dysplasia. AV may be a precancerous lesion.

Adenomyomatous hyperplasia of the extrahepatic bile duct: a systematic review of a rare lesion mimicking bile duct carcinoma

Adenomyomatous hyperplasia (AH) is a tumor-like inflammatory hyperplastic lesion. In the biliary system, AH commonly arises in the gallbladder, but AH of the extrahepatic bile duct is extremely rare. AH usually develops and is found with symptoms related to biliary stenosis or obstruction, but there are few disease-specific manifestations. It is difficult to make a definitive diagnosis by imaging or cytopathological examination; thus, surgical resections were performed in all past reported cases. The pathophysiological etiology of AH is unknown, but it is considered to be associated with chronic inflammation. According to the epidemiological findings of cases reported to date, the possibility of malignant transformation is considered to be negative. However, the symptoms and imaging findings of AH are difficult to distinguish from those of early-stage bile duct carcinoma. In the current review, we discuss the epidemiology, pathophysiology, diagnosis, and management of AH of the bile duct.

Adenomyomatosis of the Common Bile Duct and Ampulla of Vater

Adenomyomatosis is a rare benign lesion that has been observed in different sites throughout the gastrointestinal tract, most frequently in the gallbladder. Few cases have been described in the stomach, small bowel, bile ducts, and ampullary region. Adenomyomas of the vaterian system (ampulla and common bile duct) have important clinical consequences, since the majority of these lesions present with biliary tract obstruction and mimic malignant behavior. As a consequence, considering the diagnostic difficulty of these lesions, patients are often treated with extensive surgery (pancreaticoduodenectomy). We report 2 cases of adenomyomatosis: one of the ampulla of Vater and the other of the common bile duct, as well as a review of reported cases in the literature. Both of our patients presented with epigastralgia and had laboratory or endoscopic evidence of biliary obstruction. Both patients underwent endoscopic ultrasound, one of them with fine-needle aspiration; however, it was not possible to exclude the possibility of cancer. The diagnosis of adenomyoma was only confirmed by the surgical specimen after pancreaticoduodenectomy.