Adenomyoma of the Vaterian Ampulla / 한국간담췌외과학회지

Adenomyoma is a non-neoplastic tumor-like lesion that frequently occurs in the gallbladder (GB), but it is very rarely seen in the Vaterian ampulla. The pathological findings of adenomyoma are characterized by the lobule containing hyperplasia of the smooth muscle cells and ductal or glandular structures. This tumor is clearly a benign disease. However, when it develops in the Vaterian ampulla, it may be mistaken for a periampullary malignancy and could be treated with extensive surgery such as pancreaticoduodenectomy (PD). We have experienced a case of adenomyoma of the Vaterian ampulla. The patient was a 69-year-old male who developed mild hyperbilirubinemia as an initial symptom. The preoperative radiologic and endoscopic findings suggested a periampullary mass, but we could not differentiate whether it was benign or malignant. PD was performed and adenomyoma was diagnosed by pathological examination after the surgery.

Endocrine Tumors of the Pancreas Secreting Multiple Hormones / 대한내분비학회지

BACKGROUND: Endocrine pancreas tumor is a rare disease which incidence is less than 2% of all pancreatic tumors. But it comprises various types of tumor and usually secretes several hormones from one type of tumor although the patient with this tumor complains of sole symptom associated with only one hormone. The mechanism and clinical significance of multiple hormone secretion in the endocrine pancreas tumom are not yet clearly defined. METHODS: We analyzed retrospectively the clinicopathologic features of 20 cases which were operated at Seoul National University Hospital during the period between February 1989 and May 1998. RESULTS: The most common tumor was insulinoma (13 cases) and the second most common tumor was nonfunctioning tumor (6 cases). There was one case of somatostatinoma. Most of the patients with insulinoma complained of neuroglycopenic symptoms. There were 9 cases (45.0%) in which the tumors secreted more than two kinds of hormones, 7 cases in insulinoma, 2 cases in nonfunctioning tumors. Whether the tumor secreted multiple hormones was detected by the method of immunohistochemical staining. Though the tumors secreted more than two kinds of hormones, the patients with the tumors complained of symptoms which were associated with the cell type most strongly stained by immunohistochemical method. Whether or not the tumors secreted multiple hormones was not associated with the pathologic features such as tumor size, histologic patterns of the tumor, status of tumor cell differentiation and malignancy. CONCLUSION: From this results, we suggest that endocrine tumors of the pancreas secreted multiple hormones not by the mechanism of dedifferentiation from already differentiated endocrine cells but by the mechanism of neogenesis of multipotent islet stem cells. Since the relationship between the function of multiple hormone secretion in the endocrine pancreas tumors and islet stem cell would be significant, further study should be needed to find out the function of stem cells and application of stem cells to clinical use.