Adenomyomas of the Gallbladder: An Analysis of Frequency, Clinicopathologic Associations, and Relationship to Carcinoma of a Malformative Lesion

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.

Gastric type III heterotopic pancreas presenting as adenomyoma in the antrum of the stomach: a case report

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.

Adenomyoma of the small intestine in children: a 12-year experience in a tertiary referral center

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.

Ultrasound diagnosis of the small intestinal adenomyoma in children

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.

Extrauterine adenomyoma of the lesser omentum: A case report and review of the literature

RATIONALE

The extrauterine adenomyoma is rare and it is extremely rare outside the pelvic cavity. Herein, we reported the first case of a single extrauterine adenomyoma occurring in the lesser omentum.

PATIENTS CONCERNS

This case involved a 55-year-old woman who had undergone subtotal gastrectomy and omentectomy for gastric carcinoma. During postoperational pathological examination, 1 lymph node-like mass was coincidentally found in the lesser omentum. The patient had a history of hysterectomy for uterine leiomyoma 8 years ago.

DIAGNOSES

The resected 17 "lymph nodes" from the lesser omentum were routinely checked for possible metastasis of gastric carcinoma. One of lymph node-like mass was microscopically showed that it was composed of benign smooth muscle components, endometrial glands and stroma by HE staining. Therefore, adenomyoma was initially considered.

INTERVENTIONS

The lymph node-like mass was removed together with the lesser omentum during the subtotal gastrectomy and omentectomy for gastric carcinoma. No special intervention was performed for the adenomyoma.

OUTCOMES

Immunohistochemical staining confirmed that smooth muscle tissue was diffusely and strongly positive for Desmin, smooth muscle actin, estrogen receptor, and progesterone receptor, and negative for CD117, Dog-1, S100, and CD34. Endometrial glands and stroma were positive for estrogen receptor and progesterone receptor, and the endometrium interstitium was also positive for CD10. The final diagnosis of extrauterine adenomyoma occurring in the lesser omentum was established.

LESSONS

So far, to the best of our knowledge, total 53 cases of extrauterine adenomyoma have been reported in 45 English reports. The most common location for a single mass was pelvic cavity (37 cases), but rarely outside the pelvic cavity. This is the first case of a single extrauterine adenomyoma occurring in the lesser omentum.

MRI and Transvaginal Ultrasound Findings of Atypical Polypoid Adenomyoma: A Case Report

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.

[Endometrioide-type cervical adenomyoma]

Adenomyoma of the cervix is a rare, benign lesion. It is a localized form of adenomyosis, which is surrounded by a benign muscle proliferation forming a tumor similar to leiomyoma. Of the three histological variants of adenomyomas, the most frequent is the endocervical type. We present a case of a 34-year-old woman with a tumor in the lower uterine segment which enlarged during pregnancy, replacing the entire cervix and resulting in the occlusion of the endocervical canal. Ultrasound and tomography showed a mixed tumor pushing aside the uterus and bladder. Speculoscopy revealed that the tumor protruded towards the vaginal canal. Histopathological established the diagnosis of a cervical adenomyoma of the endometrioid type.

Mural Intracholecystic Neoplasms Arising in Adenomyomatous Nodules of the Gallbladder: An Analysis of 19 Examples of a Clinicopathologically Distinct Entity

Intracholecystic neoplasms (ICNs) (pyloric gland adenomas and intracholecystic papillary neoplasms, collectively also called intracholecystic papillary/tubular neoplasms) form multifocal, extensive proliferations on the gallbladder mucosa and have a high propensity for invasion (>50%). In this study, 19 examples of a poorly characterized phenomenon, mural papillary mucinous lesions that arise in adenomyomatous nodules and form localized ICNs, were analyzed. Two of these were identified in 1750 consecutive cholecystectomies reviewed specifically for this purpose, placing its incidence at 0.1%. Median age was 68 years. Unlike other gallbladder lesions, these were slightly more common in men (female/male=0.8), and 55% had documented cholelithiasis. All were characterized by a compact multilocular, demarcated, cystic lesion with papillary proliferations and mucinous epithelial lining. The lesions' architecture, distribution, location, and typical size were suggestive of evolution from an underlying adenomyomatous nodule. All had gastric/endocervical-like mucinous epithelium, but 5 also had a focal intestinal-like epithelium. Cytologic atypia was graded as 1 to 3 and defined as 1A: mucinous, without cytoarchitectural atypia (n=3), 1B: mild (n=7), 2: moderate (n=2), and 3: severe atypia (n=7, 3 of which also had invasive carcinoma, 16%). Background gallbladder mucosal involvement was absent in all but 2 cases, both of which had multifocal papillary mucosal nodules. In conclusion, these cases highlight a distinct clinicopathologic entity, that is, mural ICNs arising in adenomyomatous nodules, which, by essentially sparing the "main" mucosa, not displaying "field-effect/defect" phenomenon, and only rarely (16%) showing carcinomatous transformation, are analogous to pancreatic branch duct intraductal papillary mucinous neoplasms.

Atypical polypoid adenomyoma follow-up and management: Systematic review of case reports and series and meta-analysis

BACKGROUND

Atypical polypoid adenomyoma (APA) is a rare uterine tumor typically found in fertile age and associated with infertility. Among young nullipara women, conservative treatment is proposed despite the high recurrence rate and the association with endometrial cancer.Our aim was to assess the risk of recurrence with different conservative treatments in fertile ages and the prevalence of malignant or pre-malignant associated lesions to better address an adequate patient counselling when treatment modalities are discussed.

METHODS

This study is a systematic review and meta-analysis of case reports and case series about APA management and follow-up. A literature search was carried from Medline and Scopus for studies published from January 1, 1980 to December 31, 2018.

RESULTS

We included 46 observational studies and 296 cases in fertile women. The prevalence of APA relapse was 44% (CI.95 33-57%) and was lower in cases treated with operative hysteroscopy (22%; CI.95 11-39%) than in cases treated with blind curettage and polypectomy (38%; CI.95 15-67%). The prevalence of the concomitant or during the follow-up diagnosis of endometrial carcinoma was 16% (CI.95 9-29%). The risk of cancer development during follow-up was significantly less in cases treated with histeroscopy (10.56% new cumulative diagnosis at 5 years follow up; CI.95 0-23.7%) than blind curettage and polypectomy (35.5% new cumulative diagnosis at 5 years; CI.95 11.65-52.92%; P < .05). Medical treatment with medroxyprogesterone acetate after surgery does not reduce APA recurrence. Pregnancy was observed in 79% cases in which the desire was expressed.

CONCLUSION

This review suggests that conservative treatment performed by operative hysteroscopy is the optimal choice because it lowers the risk of recurrence, improves the accuracy of concomitant carcinoma or hyperplasia diagnosis, and leaves the possibility of future pregnancies.

Clinicopathologic Characteristics of Gallbladder Adenomyomas and the Contribution of Macroscopic Sampling in Adenomyoma Diagnosis

OBJECTIVE

Adenomyoma, a reactive and hamartomatous lesion of the gallbladder, is included in the differential diagnosis of several benign and malignant lesions. Macroscopic sampling is very important in the determination of these lesions. The agreed macroscopy protocol in recent years has been prepared by the Hepatopancreatobiliary Pathology Working Group. We aimed to evaluate the clinicopathologic properties of adenomyoma cases in the gallbladder and the contribution of new macroscopy techniques to the diagnosis of adenomyoma in the pre-protocol and post-protocol parts of a one-year period.

MATERIAL AND METHOD

Two institutes were included in the study. Adenomyoma cases diagnosed in the pre-protocol and post-protocol periods of one year duration were included in the study. Slides and demographic properties of the cases were reexamined.

RESULTS

While adenomyoma was present in 22 of 1879 gallbladder before the protocol, it was observed in 32 of 1781 gallbladders in the post-protocol period. 17 of the cases were male and 37 were female. The mean age of the cases was 51.8. 52% of the lesions were located in the fundus. A gallstone was observed in 37 cases, and cholesterolosis in 14 cases. In the comparison of the two periods, the number of cases was lower in the post-protocol period but a 0.6% increase in the diagnosis of adenomyoma was found.

CONCLUSION

Adenomyoma is one of the lesions of the gallbladder that should be recognized but can be easily overlooked macroscopically. When we conducted the sampling according to the last protocol, the increase in the diagnosis of adenomyoma showed that adequate and accurate sampling was very useful for the detection of adenomyoma in the gallbladder.

Pathogenesis of gallbladder adenomyomatosis and its relationship with early-stage gallbladder carcinoma: an overview

The exact pathogenesis of gallbladder adenomyomatosis is still lacking and some controversies over its diagnosis and treatment exist. Originally recognized as a precancerous lesion, adenomyomatosis is currently recognized by recent studies as a benign alteration of the gallbladder that is often associated with cholecystitis and cholecystolithiasis. Gallbladder carcinoma is an extremely malignant disease with a 5-year survival rate of less than 5%. Therefore, it is important to diagnose, differentiate, and confirm the relationship between adenomyomatosis and early-stage gallbladder carcinoma. However, the early clinical symptoms of adenomyomatosis are extremely similar to those of gallbladder stones and cholecystitis, increasing the difficulty to identify and treat this disease. This article summarizes the research progress on gallbladder adenomyomatosis, aiming to improve the understanding of the pathogenesis of adenomyomatosis and further provide insight for its clinical diagnosis and treatment.

Management of atypical polypoid adenomyoma of the uterus: A single center's experience

Atypical polypoid adenomyoma (APA) is a rare uterine lesion, which has a high rate of recurrence and malignant transformation. How to treat this disease is crucial for the prognosis, but there are few reports on it.We retrospectively reviewed the clinical records of all the patients diagnosed with APA after surgical therapy in our hospital. All the clinical information, pathological results, treatment, and outcome were retrieved from the clinical records.A total of 43 patients were diagnosed with APA. The median age was 56.0 years (range: 17-71 years). Primary treatments included hysteroscopic transcervical resection (TCR) of the lesions in 34 patients (79.1%), hysterectomy and bilateral salping-oophenrectomy in 5 (11.6%), hysterectomy in 1 (2.3%), and primary cytoreductive surgery for ovary cancer in 3. A total of 42 patients were followed up for a mean period of 26.9 months (range 2-57 months). Three of them recurred. One patient underwent hysterectomy after recurrence, and TCR was performed for the other 2. High-dose progestogen was given to the 2 recurrent patients after TCR.Hysterectomy is the primary therapeutic choice for postmenopausal patients with APA. Conservative treatment of APA with TCR is safe and efficient.

Endoscopic submucosal dissection for gastric adenomyoma: A rare entity of 15 cases among 571 patients with gastric submucosal eminence lesions

Gastric adenomyoma (GA) is a kind of rare gastric submucosal eminence lesions. As the malignant transformation cannot be ruled out, surgery and laparoscopic resection are usually considered. The aim of this study is to evaluate the therapeutic effect and safety of endoscopic submucosal dissection (ESD) for GA.All of the patients with gastric submucosal eminence lesions who underwent ESD from June 2008 to June 2015 in General Hospital, Tianjin Medical University, China, were identified, and patients with GA, which was confirmed by pathological evaluation, were enrolled for further analysis.Among the 571 patients who received ESD, 15 cases with uncertain diagnosis before the procedure were finally confirmed as GA. The mean age of these 15 patients was 46.93 ± 15.56 years (range: 18-73). Most of the lesions were located in antrum (12/15 patients), with 2 in the body of stomach and 1 in cardia, respectively. The mean size of the lesions was 1.47 ± 0.67 cm (range: 0.4-3.0). According to the endoscopic ultrasonography, the lesions of 14 patients originated from submucosa and 1 originated from superficial muscularis, totally with mixed echoes changes. En bloc complete resection was achieved in all of the lesions. No perforation, intraoperative bleeding, delayed bleeding, and mortalities occurred. No recurrence or metastasis was found during 1 to 67 months.ESD appears to be a feasible, safe, and effective treatment for GA with clinical presentation of gastric submucosal eminence lesions.

Extrauterine Adenomyoma of the Liver in a 50 year old Female with Pelvic Endometriosis

Extrauterine adenomyomas are defined as circumscribed tumor-like masses consisting of smooth muscle tissue, endometrioid glands and stroma. They are extremely rare tumors and similar to their uterine counterparts. We report case of a 50 year old female with an extrauterine adenomyoma of the liver associated with pelvic endometriosis. To the best of our knowledge, only fifteen cases of extrauterine adenomyomas have been reported with only one previous case in the liver. This is the first case of extrauterine adenomyoma of the liver associated with pelvic endometriosis.

Cutaneous Melanoma Metastatic to Uterine Adenomyoma: Report of a Case

Rare cases of metastasis to uterine polyps have been reported in English literature but not, to the best of our knowledge, to uterine adenomyomas. All these cases are represented by breast cancer, most of them involving tamoxifen-associated polyps. We first report a case of cutaneous malignant melanoma metastatic to uterine adenomyoma. A computed tomography scan did not reveal any further evidence of disease, suggesting that this metastatic localization may represent something more than a fortuitous case. Based on these observations it is suggested that a subset of malignant melanoma and breast cancer cells share a sort of “homing” phenomenon to polypoid lesions of uterus, due probably to the presence of some chemokines and their specific receptors. Pathologists should be aware of this possibility in order to look carefully for metastatic implants in similar lesions. It is proposed that chemokine profile of neoplastic cells can be a useful tool in predicting metastatic targets.

A mixed carcinoma of the uterus arising from an atypical polypoid adenomyoma: a case report

An atypical polypoid adenomyoma (APAM) is a benign mixed epithelial and mesenchymal uterine tumor. Patients typically present with hypermenorrhea or abnormal uterine bleeding, and the tumor is most commonly found in nulliparous or infertile women of reproductive age. The natural pathological course of an APAM remains unclear because of the rarity of the disease. The coexistence or sequential development of low-grade malignant endometrial tumors has been reported; however, reports of a mixed carcinoma arising from an APAM have not been published yet. In this report, the authors describe the case of a woman with a mixed carcinoma of the uterus arising from an APAM. This case extends our knowledge of the natural pathological course of an APAM and its etiological relationship with a mixed carcinoma of the uterus, which may contribute to the development of management strategies for an APAM.

Laparoscopic radical cholecystectomy for suspected early gall bladder carcinoma: thinking beyond convention

BACKGROUND

Gall bladder cancer (GBC) is the most common and aggressive malignancy of the biliary tract with extremely poor prognosis. Radical resection remains the only potential curative treatment for operable lesions. Although laparoscopic approach is now considered as standard of care for many gastrointestinal malignancies, surgical community is still reluctant to use this approach for GBC probably because of fear of tumor dissemination, inadequate lymphadenectomy and overall nihilistic approach. Aim of this study was to share our initial experience of laparoscopic radical cholecystectomy (LRC) for suspected early GBC.

METHODS

From 2008 to 2013, 91 patients were evaluated for suspected GBC, of which, 14 patients had early disease and underwent LRC.

RESULTS

Mean age of the cohort was 61.14 ± 4.20 years with male/female ratio of 1:1.33. Mean operating time was 212.9 ± 26.73 min with mean blood loss of 196.4 ± 63.44 ml. Mean hospital stay was 5.14 ± 0.86 days without any 30-day mortality. Bile leak occurred in two patients. Out of 14 patients, 12 had adenocarcinoma, one had xanthogranulomatous cholecystitis and another had adenomyomatosis of gall bladder as final pathology. Resected margins were free in all (>1 cm). Median number of lymph nodes resected was 8 (4-14). Pathological stage of disease was pT2N0 in eight, pT2N1 in three and pT3N0 in one patient. Median follow-up was 51 (14-70) months with 5-year survival 68.75 %.

CONCLUSIONS

Laparoscopic radical cholecystectomy with lymphadenectomy can be a viable alternative for management of early GBC in terms of technical feasibility and oncological clearance along with offering the conventional advantages of minimal access approach.

Coexistence of endometrioid adenocarcinoma in atypical polypoid adenomyoma

Atypical polypoid adenomyoma (APA) is a rare polypoid tumor of the uterus composed of atypical endometrial glands and smooth muscle cells. Concomitant development of endometrial adenocarcinoma in APA remains infrequent. We report a case of the coexistence of endometrioid adenocarcinoma in APA. A 41-year-old patient presented with abnormal genital bleeding. A polypoid mass was extruded from the external cervical os. She underwent transcervical resection of the polypoid mass arising from the lower uterine segment. Pathological examination revealed APA with the foci of well-differentiated endometrioid adenocarcinoma. Subsequently, she underwent total hysterectomy and bilateral salpingo-oophorectomy. No residual malignant lesions were found. Awareness of the close association of APA with the development of endometrial cancer is warranted. A meticulous pathological evaluation of specimen of APA is necessary for the detection of the coexistence of endometrial cancer.

Decidualization of uterine adenomyoma in a pregnant woman: a case report with immunohistochemical study

BACKGROUND

Decidualization of uterine adenomyoma has not been reported, to the best of the author's knowledge.

AIM

To report a case of uterine adenomyoma with decidualization.

CASE REPORT

A 43-year-old pregnant woman with "myoma" underwent cesarean operation and "myomectomy" at 37 gestation weeks. The operation was successful, and the baby and mother were healthy. Grossly, the "myoma" measured 12 × 10 × 10 cm, and the consistency was firm. Microscopically, the tumor was adenomyoma consisting of smooth muscle bundles and endometrial islands. Characteristically, the endometrial stroma showed marked decidualization. An immunohistochemical study showed that the decidual cells were positive for pancytokeratin AE1/3, pancytokeratin CAM5.2, cytokeratin (CK)7, CK18, vimentin, CA125, CD10, estrogen receptor (ER), progesterone receptor (PgR), and Ki-67 (labeling 1 %). They were negative for CK34βE12, CK5/6, CK8, CK14, CK19, CK20, EMA, p63, desmin, α-smooth muscle actin, S100 protein, CK34, CD68, and p53. These results show that marked decidualization occurs in adenomyoma during pregnancy, and that the decidual cells are positive for pancytokeratin AE1/3, pancytokeratin CAM5.2, CK7, CK18, vimentin, CA125, CD10, ER, and PgR.

CONCLUSION

A rare case of uterine adenomyoma with decidualization is reported.

[Clinicopathologic analysis of 14 cases of atypical polypoid adenomyoma of endometrium with the emphasis on its cancerous transformation]

OBJECTIVE

To analyze the clinicopathologic characteristics of atypical polypoid adenomyoma (APA) of endometrium, and investigate the special characteristics of cancerous transformation from APA.

METHODS

Fourteen cases of APA were collected in General Hospital of People's Liberation Army from January 2007 to March 2013. The clinical data, morphologic features, immunohistochemistry and the related literature were reviewed.

RESULTS

The median age of the 14 patients was 38 years (ranged from 23 to 72 years), only 1 patient was postmenopausal. The most common symptom was irregular vaginal bleeding (4/14), and 4 patients were identified during routine physical examination for infertility. Among 14 cases, 4 cases were diagnosed as well differentiated endometrioid adenocarcinoma originating from APA, and their median age was 35 years (ranged from 28 to 41 years); color Doppler flow imaging (CDFI) of ultrasound showed rich blood flow signal. The tumors with cancerous components were obviously larger than the usual APA (mean diameter: 4.7 versus 1.8 cm). Histologically, irregular and branched glands were embedded in fibromuscular stroma and the glandular epithelium were atypical hyperplasia in varying degrees. While carcinoma developed in the APA, the sieve, solid and papillary structures were noticeable, and necrosis were common.

CONCLUSIONS

APA is a rare lesion of the uterus. Although the clinical behavior is benign in most cases, there may be possible for some cases developing carcinomas. If the APA mass is more than 4 cm in diameter, and microscopically demonstrates prominent sieve, solid, papillary structures and necrosis, the diagnosis of carcinoma developed from APA can be made. Thorough analysis should be done before the most proper therapeutic regimen is drawn up.

Accessory and cavitated uterine mass with functional endometrium in an adolescent: diagnosis and laparoscopic excision technique

STUDY OBJECTIVE

Accessory and cavitated uterine masses (ACUM) with functional endometrium can be treated successfully with laparoscopic excision. The objectives of this report are to illustrate the surgical technique used for the removal of this uterine wall mass and to discuss the patient's clinical course and outcomes.

DESIGN

Surgical technique and description of 1 case.

SETTING

Department of Obstetrics and Gynecology, University Hospitals Case Medical Center.

PARTICIPANT(S)

A 16-year-old adolescent presented with severe dysmenorrhea and pelvic pain. Ultrasonographic examination and MRI demonstrated a cystic uterine wall mass distinct from the endometrial cavity.

INTERVENTION(S)

Laparoscopic excision of uterine mass.

RESULTS

Pathologic examination of the mass was consistent with an accessory and cavitated uterine mass. A 9-month follow-up after surgical excision of the mass confirmed complete symptom resolution.

CONCLUSIONS

ACUM is a unique and not uncommon pathologic category in the adolescent and young adult population. It is associated with severe and intractable dysmenorrhea and pelvic pain. Laparoscopic excision of these masses is justifiable, safe and feasible.

A multiple perspectives on atypical polypoid adenomyoma of uterus

Atypical polypoid adenomyoma (APA) is a rare benign uterine tumor, with less than 200 cases have been reported in English literature. Although, it is considered as a benign lesion and treated conservatively previously, more and more cases show that APA has a high rate of recurrence or residual, and is found to precede the development of carcinoma. Given the data from present research on APA, the therapy of APA becomes more complex and must be cautious, especially for the nulliparous and premenopausal patients. In addition, because of the low incidence, studies on this disease are less, and the etiology and pathogenesis of APA is still unclear. In this review, we aim to summarize recent researches concerning APA from multiple perspectives, including clinical presentation, histogenesis, immunohistochemistry and molecular features, diagnosis and differential diagnosis, treatment opinion and prognosis, which may provide theory and clinical basis for the future clinical treatment and research of this rare disease.

[Case of atypical polypoid adenomyoma of the uterine cevix]

Atypical polypoid adenomyoma (APA) is a rare benign polypoid tumor occuring in young reproductive age women. There are no specific clinical features of APA. Grossly the tumor presents as a small polypoid lession in the low uterin cavum segment and cervical canal, mimicring infiltative endocervical or endometrial carcinoma. Microscopicaly APA consists of irregular glands, as endometrial with mild cellular atypia and diffuse smooth-mussle stroma. We present a case of APA of the uterine cervix in a young woman in regard to the diagnostical and treatment obstacles usually accompaning this rare pathology.

Atypical polypoid adenomyoma mixed with endometrioid carcinoma: a case report

The following is a description of an extremely rare tumor of the uterus, malignant atypical polypoid adenomyoma (APA), admixed with well-differentiated endometroid carcinoma, in a 29-year-old patient previously treated for sterility in whom, due to the existence of a ten-millimeter sessile tumor on the uterine corpus, verified by transvaginal ultrasonography (TVUS), a hysteroscopic resection of the anomaly was performed. The patient underwent all requisite examinations and was referred to the malignant diseases panel for an examination and a decision on further treatment. As the patient wished to preserve fertility, the authors decided to continue performing regular controls at intervals of two to three months. The first subsequent control called for a TVUS examination or one using another imaging method, with a multiple endometrial biopsy with curettage of the endocervix. The results of the first examination promised that fertility could be preserved. Therapy with medroxyprogesterone acetate (MPA) in daily dosages of 200 to 500 mg was advised, which the patient intentionally did not take. A spontaneous desired pregnancy was verified following the first control.

Perivascular epithelial cell tumor arising from polypoid adenomyoma: a case report

The present report describes a rare case of a uterine perivascular epithelioid cell tumor (PEComa) arising from a polypoid adenomyoma. The patient, a 44-year-old woman with tuberous sclerosis, was incidentally found to have a uterine mass with malignant-appearing features on a computed tomography (CT) scan. Pathological examination of the hysterectomy specimen demonstrated that the tumor was composed of pale, spindle-shaped, epithelioid tumor cells which were positive for SMA and HMB-45. These findings were consistent with a PEComa arising from a polypoid adenomyoma.

[Adenomyomatosis of the gall bladder in rabbits]

Possibility of the adenomiomatosis development of the gallbladder in rabbits of different age is studied. Adenomiomatosis appeared in one of 10 animals of older age animal group. The role of serotonin in the development of adenomiomatosis is discussed.

[Menorrhagia as a consequence of atypical polypoid adenomyoma in uterus]

Atypical polypoid adenomyoma (APA) is an uncommon lesion of the uterus. APA is seen in perimenopausal women who have abnormal vaginal bleeding. We present a case of an APA, which in histological findings showed complex and atypical glands that could be confused with well-differentiated adenocarcinoma. The fact that it is a polypoid structure arising in the lower segment of uterus in younger women is helpful in diagnosing. The distinction between APA and a malignant condition is of high importance to treatment and prognosis.

[The combination of cholelithiasis, adenomyomatosis and xanthogranulomatous cholecystitis increases risk of gallbladder cancer]

The article presents a case of 18-year follow-up of 59 y. o. patient with cholecystolithiasis and adenomiomatosis, with the development of complications of rapidly progressing xanthogranulomatous cholecystitis with malignancy.

[Gall bladder adenomyomatosis]

Adenomyomatosis of the gallbladder (AMG) is not very common, however inherited and degenerative disease of the gallbladder with premalignant to malignant potential through metaplasia, occurring especially in a segmental form at higher-age patients, although the fundal form occurs more often. It can be found in 2-8.7% of resected gallbladder after cholecystecomy. In some cases, but extremely rarely, it has been found also in extrahepatic bile ducts. Correct pre-operative diagnosis does not exceed 30%, as it is often considered as an acute or chronic inflammatory gallbladder disease, same as in our case report. Disease development from the clinical point of view is mostly asymptomatic, where again the cholecystectomy is recommended.

A case of primary ovarian adenomyoma mimicking ovarian malignancy

Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is an extremely rare entity. After an extensive literature search, only four cases of primary ovarian adenomyoma appear to have thus far been reported. Here, we report a case of ovarian adenomyoma in a 39-year-old woman mimicking malignant neoplasma of the ovary, along with a brief literature review.

Clinical/pathological analysis of gallbladder adenomyomatosis; type and pathogenesis

BACKGROUND/AIMS

The aim of this study was to analyze the clinical/pathological outcomes of patients that underwent surgery for gallbladder adenomyomatosis, to clarify the characteristics of the type and pathogenesis of adenomyomatosis.

METHODOLOGY

From May 1997 to March 2008, 4704 consecutive patients underwent cholecystectomy at Ajou University Medical Center. Among them, 113 (2.4%) patients that were histopathologically diagnosed with adenomyomatosis or adenomatous hyperplasia were selected for this study. The patients were divided into a fundal type group and a segmental/diffuse type group, and the specimens reviewed with Hematoxylin-Eosin (H & E) and immunohistochemical stainings.

RESULTS

Sixty-three patients were male and 50 female; the age ranged from 17 to 76 years of age. The fundal type was the most common type. Gallstones were present in 69.9% of the patients. In the analysis of the fundal and segmental/diffuse types, gallstones were present in 23 patients with fundal type and in 53 patients with segmental/diffuse type; this difference was statistically significant (p < 0.05). Review of H & E staining showed that the most common findings were grade 1 (n = 14) in the fundal type and grade 2 (n = 23) in the segmental/diffuse type; there was a significant difference in the inflammatory grade (p < 0.05). Immunohistochemical staining showed expression of vimentin, as a mesenchymal marker in 28.0% of cases (n = 16).

CONCLUSIONS

The fundal type differed from the segmental/diffuse type based on the clinical/ pathological features; it had a lower frequency of gallstones and a lower inflammatory grade. In addition, no cancer was identified in the resected gallbladders of patients with adenomyomatosis. The findings suggest that the Rokitansky-Aschoff sinuses (RAS) were associated with acquired motility, based on the expression of vimentin, consistent with an epithelial-mesenchymal transition.

Collagenous spherulosis associated with adenomyoepithelioma of the breast: a case report

BACKGROUND

Collagenous spherulosis (CS) associated with an adenomyoepithelioma (AME) of the breast is rare. This report describes a case of CS associated with an AME of the right breast, including the cytologic and histopathologic findings.

CASE

A 51-year-old female presented with a slow-growing left breast mass that had been present for 5 months. A preoperative core needle biopsy showed the presence of layers or sheaths of myoepithelial cells around epithelial-lined spaces. Imprint cytology of the surgical material showed the presence of bundles of spindle cells with an admixture of epithelial cells. Spherical structures were also found. They were translucent or slightly light green with Papanicolaou staining and metachromatic with Giemsa staining. Grossly, the 1.5-cm lesion was solid and embedded within the breast parenchyma. Microscopically, it was composed of spindle or polygonal cells with eosinophilic cytoplasm and an epithelium lining spaces with many spherical structures. The spindle or polygonal cells were positive for myoepithelial markers and the epithelium was positive for epithelial markers by immunohistochemistry.

CONCLUSION

There is no previous report describing the cytologic findings of CS associated with an AME of the breast. AMEs should therefore be considered an underlying pathology of CS of the breast.

Incidental diagnosis of atypical polypoid adenomyoma in a young infertile woman

Atypical polypoid adenomyoma (APA) is considered to be a rare, benign form of a polypoid mass that exhibits glandular and squamous epithelial cell proliferation with varying degrees of atypia in association with cellular smooth muscle stroma. More frequently it manifests during the reproductive and premenopausal age with a reported mean age of 40 years. The published series indicates an average risk of endometrial carcinoma of 8.8% in women with a history of polypoid adenomyoma. The differential diagnosis of APA includes complex endometrial hyperplasia with atypia, invasive adenocarcinoma, adenofibroma, adenosarcoma and carcinosarcoma. The recognition of these unusual benign uterine tumors is very important, because they can easily be misdiagnosed. Treatment may vary depending on the patient's age, her desire to preserve fertility and the severity of her symptoms. We present a case of an infertile 39-year-old woman with an incidental diagnosis of APA.

Laparoscopic excision of uterine adenomyomas

OBJECTIVE

To present a series of six consecutive women with adenomyomas who were successfully managed with a standard treatment strategy to elucidate the feasibility and the effectiveness of laparoscopic treatment of adenomyomas.

DESIGN

Cross-sectional case series.

SETTING(S)

Obstetrics and gynecology department of a tertiary academic hospital and endoscopic unit of a private hospital.

PATIENT(S)

The six cases described in this report were nonpregnant women of reproductive age (mean age, 34.8 years old; range, 29-38 years) who presented in the outpatient gynecological clinic for yearly routine visit (one patient), dysmenorrhea and menorrhagia (three patients), and history of pregnancy loss (two patients).

INTERVENTION(S)

Laparoscopic excision of uterine adenomyomas.

MAIN OUTCOME MEASURE(S)

Feasibility and effectiveness of laparoscopic management of adenomyomas.

RESULT(S)

The average operating time was 100.5 minutes, and the average estimated blood loss was 163 mL. No event complicated the intraoperative and the postoperative course of these cases, and no case was converted to laparotomy. The mean follow-up was 13.7 months, with complete regression of the symptoms.

CONCLUSION(S)

Excision of adenomyomas presents intraoperative peculiarities involving difficulties in their dissection and manipulation. Laparoscopic management of these lesions appears to be safe and feasible with good follow-up results and limited recurrence rates.

Clinics in diagnostic imaging (121). Gallbladder adenomyomatosis

Adenomyomatosis of the gallbladder is a condition of benign hyperplasia of unknown aetiology, characterised by local or diffuse thickening of the muscular layer, with invagination of the epithelium, forming Rokitansky-Aschoff sinuses. Magnetic resonance imaging features are specific and help in the definitive diagnosis of this condition. A 50-year-old obese woman presented with episodic pain in the right hypochondrium. Ultrasonography, computed tomography and magnetic resonance imaging showed typical features of adenomyomatosis, which was subsequently confirmed by laparoscopic cholecystectomy.

Adenomyoma of the jejunum --- a rare cause of gastrointestinal bleeding

Adenomyoma of the small intestine is rare. It occurs mostly in the periampullary region or ileum. The common presentations are intussusception and intestinal or biliary obstruction, depending on the location. To our knowledge, gastrointestinal (GI) bleeding from a jejunal adenomyoma has not been reported previously. We present a 74-year-old female patient who suffered intermittent tarry stool passage for 1 month. Initial upper GI endoscopy, colonoscopy and computed tomography failed to find the bleeder. A papilla-like tumor with central depression and active bleeding in the proximal jejunum was found by push enteroscopy. Exploratory laparotomy showed a submucosal nodule about 1.5 cm in size located about 20 cm distal to the Treitz ligament. Wedge resection was carried out. Pathologic examination revealed that the tumor was composed of some cystic exocrine-type ducts and bundles of smooth muscle, indicating adenomyoma. The patient was symptom-free following operation.

A case of endometrial carcinoma arising in a 36-year-old woman with uterine atypical polypoid adenomyoma (APA)

Atypical polypoid adenomyomas are tumors of low malignant potential. We present a case of endometrial carcinoma arising in a 36-year-old woman with atypical polypoid adenomyoma. The diagnosis and treatment of such a tumor is discussed through an English literature review.

Isolated adenomyotic cyst associated with severe dysmenorrhea

A case of a 23-year-old, nulliparous female with a very rare isolated adenomyotic cyst inducing severe dysmenorrhea was seen. Transvaginal ultrasonographic tomography and magnetic resonance imaging (MRI) showed a 3 x 3-cm cystic mass within the left anterior wall of the uterine corpus. The cystic space was filled with hyperintense fluid on T1-weighted images, which was surrounded by hypointense tissue beside the right uterine corpus on T2-weighted images. The case was preliminarily diagnosed using MRI as having cavitated rudimentary uterine horn. However, hysterosalpingography excluded the possibility of uterine anomaly. A hemorrhagic adenomyotic cyst measuring 3 cm within the left anterior wall of the uterine corpus was surgically removed. There was no evidence of diffuse adenomyosis uteri. Dysmenorrhea completely disappeared postoperatively.

Pregnancy outcome of a patient with atypical polypoid adenomyoma

OBJECTIVE

Detailed description and follow-up of a patient with atypical polypoid adenomyoma and infertility, from investigation until delivery of a healthy baby.

DESIGN

Case report.

SETTING

Tertiary infertility center.

PATIENT(S)

A patient suffering from persistent APA and infertility.

INTERVENTION(S)

Danggui (Angelica sinensis) and low-dose aspirin.

MAIN OUTCOME MEASURE(S)

Pregnancy and live birth.

RESULT(S)

Conception after Danggui but intrauterine death at 25 weeks. Successful live birth after Danggui plus low-dose aspirin.

CONCLUSION(S)

Danggui corrected atypical polypoid adenomyoma and led to pregnancy twice in the same patient. Low-dose aspirin may improve the circulation in the placental bed and lead to live birth.

Single large cystic adenomyoma of the uterus after cornual pregnancy and curettage

A case of single large cystic adenomyoma of the uterus (anechoic area 1.6 cm in diameter) was diagnosed by surgery and histopathologic analysis more than 3 years after a transcervical curettage for an early right-cornual pregnancy.

Adenomyomatous Hyperplasia of the Gallbladder With Perineural Invasion

We report 9 examples of segmental adenomyomatous hyperplasia of the gallbladder with perineural invasion. Five patients were women and 4 men. Their ages ranged from 49 to 81 years (mean age 64 y). Eight patients had gallbladder calculi. The original pathologic diagnosis of adenocarcinoma was made in 5 patients and of "adenoma malignum" in one. Six patients are disease-free for 2 to 11 years following cholecystectomy, 1 patient died of unrelated causes and 2 were lost to follow-up. Histologically 2 types of adenomyomatous hyperplasia were recognized. The first one characterized by numerous Rokitansky-Aschoff sinuses (RASs) was accompanied by smooth muscle hyperplasia and an expanded subserosal layer containing numerous nerve trunks (6 cases). The second type was characterized by an extensively fibrotic gallbladder wall with numerous RASs but with few or no smooth muscle bundles and an expanded subserosal layer containing abundant nerve-trunks (3 cases). Perineural (7 cases) and intraneural invasion (2 cases) was identified only in the subserosal layer. The lack of p53 reactivity and the very low MIB-1-labeling index provide additional support to the non-neoplastic nature of the lesion. The pseudoinvasive pattern of the RASs, reactive epithelial atypia, and the perineural and intraneural invasion probably contributed to the erroneous diagnosis of adenocarcinoma or "adenoma malignum." The mechanism by which the epithelial structures "invaded" the perineural spaces and the nerves is unclear. We favor the hypothesis that the migration of the benign glandlike structures into the nerves is related to the production of chemotactic factors or signaling substances and the activation of cell receptors.

Primary cutaneous adenomyoepithelioma

An 83-year-old Caucasian woman presented to her dermatologist with a 5-cm subcutaneous tumor on her right thigh. The lesion had been present for many years, but had recently enlarged. Incisional biopsy showed a multinodular tumor composed of variably sized glands comprised of a luminal layer of epithelial cells surrounded by one or more layers of myoepithelial cells. The histopathologic features resembled those of adenomyoepithelioma, an uncommon neoplasm usually encountered within the breast. Primary cutaneous adenomyoepithelioma is very rare yet shares histopathologic features with common cutaneous lesions such as spiradenomas and benign mixed tumors (chondroid syringomas). Primary cutaneous adenomyoepithelioma is part of the spectrum of epithelial-myoepithelial tumors that includes benign mixed tumor, myoepithelioma and myoepithelial carcinoma. This rare tumor may mimic malignant lesions including metastatic adenocarcinoma. Like its breast counterpart, primary cutaneous adenomyoepithelioma should probably be regarded as a neoplasm of borderline malignant potential.

Clinicopathologic characteristics of uterine adenomyoma in pregnant women

OBJECTIVE

To study the clinicopathologic characteristics and the treatment means of pregnant women with uterine adenomyoma.

DESIGN

Retrospective, consecutive, controlled study.

SETTING

University hospital for obstetrics and gynecology.

PATIENT(S)

Eighteen pregnant women with uterine adenomyoma.

INTERVENTION(S)

Data collection and statistical analysis.

MAIN OUTCOME MEASURE(S)

Eighteen pregnant women with uterine adenomyoma were diagnosed by excision of adenomyoma tissue during cesarean section and histopathology. The 18 subjects were retrospectively divided into treatment group (achieving this pregnancy by treatment; 10 cases) and control group (having no difficulty conceiving; 8 cases). The clinicopathologic characteristics and treatment means of the patients were analyzed retrospectively.

RESULT(S)

The mean volume of uterine adenomyoma in the treatment group was larger than that of the control group. The methods of treating women with uterine adenomyoma-associated infertility include GnRH agonist (GnRH-a: 6 cases), GnRH-a and IVF and embryo transfer (3 cases), and traditional Chinese medicines (1 case).

CONCLUSION(S)

Severe uterine adenomyoma correlate with infertility in women of childbearing age. GnRH-a is effective in treating women with uterine adenomyoma-associated infertility.

Polypoid endocervical adenomyoma: A case report with clinicopathologic analyses

A case of polypoid endocervical adenomyoma (PEA) in the uterine cervix was encountered in the uterine cervix of a 56-year-old woman. Grossly, a well-circumscribed polypoid tumor was observed protruding from the uterine cervix. Based on the findings of imaging studies, it was assumed to be an adenoma malignum in the uterine cervix. The tumor was composed of a mixture of proliferating glands of endocervical type and fascicles of smooth muscle. No distinct nuclear anaplasia, architectural abnormality or any evidence of destructive stromal invasion was observed. Adenoma malignum, which shows a gastric phenotype with immunoreactivity for HIK-1083, was a serious diagnostic possibility. In the present case, the tumor was a well-circumscribed polypoid lesion, with no cytologic or architectural abnormality; however, focal immunoreactivity was shown for HIK-1083, which thus suggested it to be PEA. Therefore, the results of these ancillary diagnostic modalities should be interpreted with caution and combined with the gross and light microscopy findings.