1/27. Completely laparoscopic resection of a rare pyloric tumor with laparoscopically sutured gastroduodenostomy.We report the case of a 31-year-old woman who presented with epigastric pain and weight loss. Esophagogastroduodenoscopy revealed a submucosal mass in the distal antrum and pylorus. Endoscopic biopsy of the mass was nondiagnostic. A CT scan confirmed a 3.0-cm mass in the posterior wall of the distal antrum. She underwent laparoscopic resection of the distal antrum and pylorus with end-to-end gastroduodenostomy. Pathologic examination showed an adenomyoma of the antrum and pylorus. Her postoperative course was uncomplicated, and she continues to do well 38 months postoperatively. Gastric adenomyoma is a rare, benign intramural tumor of the antrum and pylorus. Fewer than 40 cases have been described in the literature. The lesions are generally within 4 cm of the pylorus. Histologically, they are characterized by ductal structures lined by cuboidal to columnar epithelium surrounded by smooth muscle bundles and, occasionally, Brunner's-type glands and heterotopic pancreas. Treatment is by resection, and recurrence has not been reported. Laparoscopic resection of portions of the stomach has been reported. Side-to-side gastrojejunostomies (Billroth II) performed laparoscopically have been reported. This is the first report in the English-language literature of a completely laparoscopically performed sutured gastroduodenostomy. Technical details of the procedure and adenomyomas are discussed.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/27. Adenomyomatous hyperplasia of the papilla of Vater: A sequela of chronic papillitis?A case of adenomyomatous hyperplasia of the papilla of Vater is described. The lesion presented as a small polypoid tumor projecting into the duodenal lumen, causing obstruction and dilatation of the common bile duct. Serial cross-section of the ampulla showed diffuse thickening of the muscular layer corresponding to Oddi's sphincter, with resulting narrowing of the lumen. Many ductal or glandular components were dispersed within the mucosa and the muscular layer and were admixed with lymphocytes, a few lymphoid aggregates, and fibrosis. Based both on the absence of cellular atypia and the presence of inflammation, fibrosis, and preservation of the normal architecture of the ampulla, we favor the interpretation that this hyperplastic lesion represents a sequela of chronic papillitis. The different diagnoses for this lesion are presented along with a review of the literature.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
3/27. adenomyoma of the common bile duct.An unusual case of adenomyoma of the common bile duct is reported. A 31 year-old woman with intermittent epigastralgia was found to have cholestasis and stenosis of the common bile duct. A malignant tumor could not be excluded. Resection of the common bile duct with the tumor was performed with choledochojejunostomy reconstruction. The tumor consisted of glandular hyperplasia and proliferation of smooth muscle fibers and fibrous connective tissue. The patient was well at the 30-month follow-up. Although the benign tumors of the extrahepatic bile ducts are rare, the clinical importance lies in the recognition that they can cause biliary tract obstruction. Intra-operative frozen section for histologic examination is required to make the diagnosis and plan the surgical procedure. Complete extirpation of the lesion is recommended. A radical operation is not necessary.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
4/27. Exfoliative cytology of atypical polypoid adenomyoma. A case report.BACKGROUND: An atypical polypoid adenomyoma (APA) is a well-defined entity. It occurs in the endometrium, lower uterine segment and endocervix. It is usually composed of atypical complex glands with squamous metaplasia admixed with myofibromatous stroma. CASE: A 35-year-old female presented with one-year history of irregular menstrual periods. A diagnosis of adenocarcinoma in situ was rendered on her cervicovaginal smear. Pelvic examination revealed an enlarged uterus due to a leiomyoma. Colposcopic examination revealed a 0.6-cm, sessile, polypoid mass at the junction of the endocervix and ectocervix. A cone biopsy of the lesion showed irregular, endometrial-type glands embedded in a prominent myofibromatous stroma. The atypical glandular component of the mass demonstrated varying degrees of architectural complexity, ranging from simple to complex hyperplasia. In tissue sections the lesion was diagnosed as APA of the cervix. The patient underwent a hysterectomy for the leiomyoma. The hysterectomy specimen showed an 8.5-cm leiomyoma. The cervix and uterine corpus revealed no residual APA. CONCLUSION: APA of the cervix should be considered among the differential diagnoses of atypical glandular cells of undetermined significance. The diagnosis of APA cannot be made on cytology; the final diagnosis requires histologic confirmation.- - - - - - - - - - ranking = 4keywords = gland (Clic here for more details about this article) |
5/27. Uterine adenomyoma of endocervical type.A uterine adenomyoma of endocervical type was presented histopathologically in a 44-year-old woman. She had a mural tumor of the uterine endocervix, which showed a well-circumscribed margin and multiple cysts filled with mucin. Histologically, the tumor was composed of a proliferation of endocervical glands and smooth muscle. The glandular epithelial components were cystic and occasionally papillary, but neither component showed cytological atypia. A differential diagnosis of the uterine endocervical tumor should include adenomyoma of endocervical type.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
6/27. Multilocular cystic adenomyoma of the pelvic cavity: A rare clinical and histological entity in a young man.We report a large complex cystic pelvic mass encountered in a 16-year-old man complaining of perineal discomfort. A large and elastic hard mass was palpated on the right anterior wall of the rectum with no discernible prostate on digital rectal examination. Prostatic tumor markers were elevated. Excretory urography and urethrocystography showed a filling defect with a smooth edge on the right side of the bladder. magnetic resonance imaging demonstrated a mass with a mosaic pattern between the right side of the bladder and the rectum. We performed ultrasound-guided transrectal needle core biopsy of the mass. The pathologist suspected hyperplastic glandular epithelium of prostatic origin with focal inflammatory cell infiltration, but there was no sign of malignancy. We thought that the tumor arose from the prostate. Surgery was successfully performed. The tumor was located on the right side of the pelvic cavity and adhered to the right lobe of the seminal vesicle. En bloc excision was performed. This lesion histologically proved to be a multilocular prostatic tissue with a seminal vesicle component, without communication to the surrounding tissue. Such a lesion has not previously been reported in the literature.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
7/27. Simultaneous appearance of an adenomyoma and pancreatic heterotopia of the stomach.Adenomyomas of the stomach are rare tumours characterised by duct/gland-like structures embedded within a smooth muscle stroma. Although the histogenesis of adenomyomas remains unclear, the histological appearance has justified the assumption that these are abortive forms of pancreatic heterotopia. We report an unusual case with simultaneous and independent appearance of both adenomyoma and pancreatic heterotopia of the stomach including immunohistochemical characterisation, supporting the concept of a common histiogenetic origin of both lesions.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
8/27. Endocervical adenomyoma. A case report with histochemical and immunohistochemical studies.We report a case of adenomyoma of endocervical type arising in a 44-year-old female. Grossly, a well-circumscribed tumor protruding from the right side of the uterine cervix was seen which was assumed to be an ovarian tumor by imaging studies carried out preoperatively. The tumor was composed of a mixture of proliferating glands of endocervical type and fascicles of smooth muscle cells. There was no distinct nuclear anaplasia in the proliferating glands, there were no architectural abnormalities, and there was no evidence of destructive stromal invasion such as desmoplasia. Minimal deviation adenocarcinoma, which shows a gastric phenotype with immunoreactivity for M-GGMC-1 and predominantly PAS-positive neutral mucin, was a serious diagnostic possibility, but the lesion was well-circumscribed, cytologic and architectural abnormalities were absent, and staining for M-GGMC-1 was negative, which suggested a diagnosis of endocervical adenomyoma. An increased Ki-67 labeling index by up to 20%, the presence of predominantly PAS-positive neutral mucin, and membranous immunoreactivity for CEA in limited areas were diagnostic pitfalls, which could lead to an erroneous diagnosis of minimal deviation adenocarcinoma of the uterine cervix. Therefore, the results of these ancillary techniques should be interpreted with caution and combined with gross and light microscopic features.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
9/27. Uterine adenomyoma with uterus-like features: a report of two cases.Two uterine adenomyomas with unusual features are presented. Case 1 was a 43-year-old woman who had a 1-year history of menorrhagia and dysmenorrhea. The uterus showed a 3-cm-sized mass attached to the posterior wall of the lower uterine segment. On section, there was a well-circumscribed, submucosal cystic mass with a thick muscular wall. Histologically, the cavities were lined by well-developed secretory-phase endometrium and surrounded by smooth muscle, like a small uterus. Case 2 was a 52-year-old woman who visited the hospital because of itching sensation on the vulva. On physical examination, the mass was found on the left side of the pelvis. The enlarged uterus had an 8-cm-sized protruding mass from the left side of the lower uterine segment. On section, the mass was cystic and solid. Histologically, the cysts were lined by thin basalis-type endometrial glands and stroma, and the solid portion was composed of smooth muscle and fat cells.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
10/27. adenomyoma of the small intestine in an adult: a rare cause of intussusception.adenomyoma of the small intestine is an extremely rare entity characterized by a mixture of glandular structures lined by columnar epithelium, with intervening bundles of smooth muscle. We report a case of adenomyoma of the jejunum that caused intussusception in an adult. Histologically, the morphologic features are typical of adenomyoma and are noteworthy for the extensive cystic change.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
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