Gist sincrónico con adenomioma gástrico: Reporte de caso y revisión de la literatura / Synchronous gist with gastric adenomyoma: Case report and literature review

Introducción: La colisión de dos tumores de diferente estirpe celular en un mismo órgano es infrecuente; a pesar de las asociaciones descritas en la literatura, el hallazgo de GIST con adenomioma en sincronismo, llama aún más la atención debido a sus distintos orígenes celulares. Reporte de caso: Presentamos el caso de una paciente mujer de 57 años de edad, quien es sometida a cirugía de resección doble en cuña, y distintos exámenes incluido el anátomo-patológico. Conclusión: Se demuestra la presencia de tumores sincrónicos, GIST gástrico y adenomioma gástrico, a pesar de la infrecuencia de este hallazgo.

Background:The collision of two tumors of different cell lines in the same organ is infrequent; even though, the associations described in the literature, the finding of synchronous GISTwith adenomyoma draws even more attention due to its different cellular origins. We present the case of a 57-year-Case report:old female patient who underwent double wedge resection surgery and various examinations, including pathology. Conclusion:The presence of synchronous tumors, gastric GIST and gastric adenomyoma is demonstrated,despite the infrequency of this finding.

MRI and Transvaginal Ultrasound Findings of Atypical Polypoid Adenomyoma: A Case Report / 中国医学科学杂志(英文版)

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.

Adenomiosis apendicular: reporte de dos casos / Appendicular adenomiosis: report of two cases

Resumen Los adenomiomas son tumoraciones benignas constituidas por un agregado nodular de músculo liso, glándulas endometriales y estroma endometrial. La presencia de adenomiomas fuera del útero es un hallazgo infrecuente. Presentamos dos casos de adenomiomas extrapélvicos localizados en el apéndice. El estudio histológico resultó esencial para el diagnóstico.

Abstract Adenomyomas are a benign tumor compound of smooth muscle nodular aggregate, endometrial glands and endometrial stroma. Adenomyomas presenting outside uterus are a rare finding. Here we report two extrapelvic adenomyomas of the appendix. Histological examination was essential for diagnosis.

Adenomiomatosis vesicular en un adolescente, una afección muy rara / Adenomyomatosis of the gallbladder in an adolescent, a very rare condition

La adenomiomatosis vesicular es una enfermedad degenerativa adquirida que se caracteriza por proliferación epitelial con hipertrofia de la capa muscular y formación de trayectos fistulosos, conocidos como senos de Rokitansky-Aschoff. La adenomiomatosis se diagnostica principalmente mediante ecografía. No se conocen cabalmente la patogenia, la patología ni las indicaciones para cirugía de esta afección. Es sumamente rara en niños. En este artículo, presentamos el caso de un varón de 17 años con adenomiomatosis vesicular tratado adecuadamente con una colecistectomía laparoscópica

Adenomyomatosis of the gallbladder is an acquired, degenerative disease characterized by epithelial proliferation with hypertrophy of the muscularis layer with forming of sinus tracts, termed Rokitansky-Aschoff sinuses. Adenomyomatosis is diagnosed mainly by ultrasonography. The pathogenesis, pathology, and indications for surgery in this condition are not well understood. It is an extremely rare condition in children. We present a case of a 17-year boy with adenomyomatosis of the gallbladder successfully managed with laparoscopic cholecystectomy,

Efficacy of Transvaginal Sonography-guided Laparoscopic Percutaneous Microwave Coagulation Therapy in Treatment of Uterine Adenomyoma / 中国医学影像学杂志

Purpose To explore the short-term clinical efficacy and application value of transvaginal sonography-guided laparoscopic percutaneous microwave coagulation therapy in the treatment of uterine adenomyoma.Materials and Methods Forty patients with uterine adenomyoma who visited the Central Hospital of Wuhan from October 2015 to October 2016 were selected in this study.These patients were invalid in traditional treatment for severe dysmenorrheal,but still unwilling to excise uterus.Microwave needles were placed into uterine adenomyoma to conduct percutaneous microwave coagulation therapy under the whole-process monitoring and guidance of laparoscope and transvaginal ultrasonography.Results All of 64 nidi in the 40 patients were ablated successfully,and none had damage to peripheral vital organs or vessels.Intraoperative hemorrhagic volume was extremely small.Postoperative menstrual blood volume and dysmenorrheal severity were improved notably,but none had obvious recurrence until now.The uterine volumes at postoperative one,three and six months as well as one year were (135.0±73.2) cm3,(108.2 ± 62.9) cm3,(91.4 ± 58.4) cm3,and (84.8 ± 50.0) cm3,respectively,all were evidently smaller than the (207.2± 97.4) cm3 before operation (P＜0.01).The n idus sizes at postoperative one,three and six months as well as one year were (42.3±34.2) cm3,(30.6±27.4) cm3,(24.7±23.0) cm3 and (23.0± 19.4) cm3,respectively,all were evidently smaller than the (67.9±48.2) cm3 before operation (P＜0.01).There were also significant differences in laboratory examinations of CA125 and CA199 before and after operation (P＜0.01).Conclusion Percutaneous microwave coagulation therapy as a non-invasive technique that can both maintain patients' uteruses and resolve their pain,is more safe and real-time under the monitoring of laparoscope,thus being promising as a new routine for the treatment of uterine adenomyoma.

Atypical polypoid adenomyoma of the uterus: a clinicopathological review of 27 cases / 中华妇产科杂志

Objective To investigate the clinical and pathological characteristics of atypical polypoid adenomyoma (APA) for improvement of the diagnosis, different diagnosis and treatment of the disease. Methods The clinical data, pathological characteristics, and the follow-up information were retrospectively analyzed in 27 cases of APA admitted in Peking Univeristy People′s Hospital from 2007 to 2016. Results The median age was 42.6 years old (range 25-60 years old). Fifteen patients were nullipara, 2 patients were postmenopausal. The most common presenting symptom was abnormal uterine bleeding (81%,22/27). Leisions were obtained by using hysteroscopy in 23 cases, hysterectomy 3 cases and dilatation and curettage 1 case. Fertility preserving treatments were performed in 10 patients who had strong desire for fertility, among which 1 case progressed into endometrial carcinoma. Among 15 patients underwent hysterectomy and (or) bilateral salpingo-oophorectomy, 9 cases of them had endometrial atypical hyperplasia. Endometrial carcinoma along with APA were found in three patients, 2 cases of them underwent hysterectomy and bilateral salpingo-oophorectomy and pelvic lymphadenectomy, the other one received medication for fertility preservation. Follow up information were available in 24 cases(89%,24/27)with a median follow up of 46 months (range 4-108 months), 1 case recurred and 1 case progressed into endometrial carcinoma. One case died of other malignancy, while the other patients were alive. Conclusions APA is a rare uterine neoplasm mixed with epithelial and mesenchymal component. It occurs mostly in childbearing-age women and its diagnosis is dependent on pathology. Although it′s clinical course is benign, there is risk of co-existance of endometrial carcinoma and endometrial atypical hyperplasia. For those who has desire of fertility, the treatment strategy is completely removed the lesion and closely followed up. For those who do not desire to preserve fertility, hysterectomy may be an option.

Evaluation Of Diffusion-Weighted Imaging And Apparent Diffusion Coefficient Mapping Using Different B-Values For Magnetic Resonanceguided Focused Ultrasound Surgery: A Preliminary Study For Uterine Fibroid And Adenomyoma

The study was taken to assess the feasibility of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping using different b-values for magnetic resonance-guided focused ultrasound (MRgFUS) treatment of uterine fibroid and adenomyoma. The contrast-enhanced T1-weighted image (cT1WI) as well as DWIs and ADC maps of different b-values (i.e. 200, 600 and 800 s/mm2) were obtained from nine fibroid and five adenomyoma patients, immediately after, and 12 months after MRgFUS treatment. The image contrast score, non-perfused volume (NPV) and NPV ratio obtained were compared to determine the feasibility of DWI and ADC mapping for MRgFUS treatment outcome evaluation. Our finding showed thatimmediately after MRgFUS treatment, the DWI acquired using 200 s/mm2 b-value gave the highest image contrast score among all other b-values. The NPV calculated from DWI of 200 s/mm2 showed the best correlation (R2 = 0.938) with post-contrast NPV. At 12 months follow-up, there was no specific b-value considered as significantly superior to others in terms of image contrast. However, the NPVs and NPV ratios obtained from all DWIs and ADC maps of different b-values were in good agreement with the post-contrast NPV and NPV ratio. We observed that the DWI, particularly obtained with a low b-value (i.e. 200 s/mm2), is feasible for delineation and quantitative volumetric evaluation of the ablated region immediately after the MRgFUS treatment. At 12 months follow-up, both DWIs and ADC maps are feasible for NPV and NPV ratio calculation.

Application of virtual touch tissue quantification imaging in diagnosing of uterine hysteromyoma and adenomyoma / 实用医学杂志

Objective To evaluate the performance of virtual touch tissue quantification imaging (VTQ) for differential diagnosing in uterine hysteromyoma and adenomyoma. Methods Blood flow parameters and SWV (shear wave velocities) from 42 regular hysteromyomas,14 abnormal hysteromyomas and 25 uterine adenomyomas were compared and analyzed through color Doppler. Results The SWV of regular hysteromyomas was on average of (2.72 ± 0.31) m/s;that of abnormal hysteromyomas (1.88 ± 0.25) m/s;while the SWV of uterine adenomyomas was on average of 1.91 ± 0.27 m/s. The mean SWV in regular hysteromyomas group was significantly higher than that in abnormal hysteromyomas group and uterine adenomyomas group (P 0.05).The resistance index and SWV of uterine hysteromyomas and adenomyomas had positive correlation (r = 0.753,0.544,0.506,P < 0.05). Conclusion VTQ can quantify the stiffiness of uterine hysteromyoma and adenomyoma.

Adenomyoma in the Body of Stomach Presenting as a Pedunculated Polyp Treated by Endoscopic Mucosal Resection

An adenomyoma is a rare, benign tumor, characteristically composed of a mixture of glandular structures with intervening bundles of smooth muscle. An adenomyoma is considered to be a variant of an ectopic pancreas, without exocrine or endocrine components. Adenomyomas of the gastrointestinal tract are found most frequently in the stomach and the small intestine is rarely involved. Gastric adenomyoma is frequently localized in the antrum or pylorus and very rarely occurs in the body. Adenomyomas often appear as a submucosal mass. A 48-year-old man was referred for further management of a 2.5-cm pedunculated polyp in the stomach. The resected tumor was diagnosed as an adenomyoma of the stomach. To the best of our knowledge, this is the first case reported in the literature of gastric adenomyoma that presented as a pedunculated polyp in the body and was treated completely with endoscopic resection.

A Case of Adenomyomatous Hyperplasia of the Distal Common Bile Duct Mimicking Malignant Stricture / 대한소화기학회지

Adenomyomatous hyperplasia is a reactive malformation or non-neoplastic tumor-like lesion frequently observed in the gallbladder, stomach, duodenum and jejunum, but rare in the extrahepatic bile duct. A 42-year-old man with epigastric discomfort had a stricture in the common bile duct on initial CT scans. Initially, it was regarded as a malignant lesion with some evidence, but histopathologic examinations of multiple biopsies obtained by multiple sessions of endoscopic retrograde cholangiopancreatography showed no evidence of malignancy. The patient had undergone the pylorus preserving pancreaticoduodenectomy because of the possibility of malignancy; however, the final diagnosis was adenomyomatous hyperplasia. It is important to distinguish a malignancy from benign biliary stricture with endoscopic biopsies. Surgery for suspected biliary malignancy often reveals benign lesions. Therefore, a correct diagnosis is important before deciding upon treatment of bile duct stricture. In conclusion, in younger patients with bile duct stricture where there is no evidence of histologic malignancy despite multiple biopsies, the possibility of benign disease such as adenomyomatous hyperplasia should be considered, to avoid unnecessary radical surgery.

Ampulla of Vater Adenomyoma with Dilatations of Biliary and Pancreatic Duct / 대한췌담도학회지

Adenomyoma is a non-neoplastic lesion that frequently occurs in the gallbladder, but it's rarely found at the ampulla of Vater. When it develops at the ampulla of Vater, it may be mistaken for a periampullary malignancy. A 64-year-old asymptomatic male patient visited to our hospital with abnormal sonogram findings. Abdominal computed tomography and magnetic resonance cholangiopancreatography showed dilatations of common bile duct and main pancreatic duct. However, there was no definite ampullary mass. We performed endoscopic biopsies and endoscopic ultrasonography-guided fine needle aspiration. But the results were negative for malignant cells. Because we could not completely rule out malignancy, pylorus preserving pancreato-duodenectomy was performed. Histologically, hyperplastic components are intermixed with smooth muscle fibers in the subepithelial portion of ampulla of Vater. Awareness of adenomyoma of the ampulla of Vater is very important because of their clinical and endoscopic similarities to ampullary tumors.

Adenomiomatosis de la vía biliar, incidencia de 10 años y revisión de la bibliografía actual / Adenomyomatosis of the biliary tree, ten-year incidence and review of current literature

Introducción. La adenomiomatosis es una entidad anatomo-clínica de difícil diagnóstico. Se puede clasificar en generalizada, segmentaria y localizada. Suele presentarse con síntomas de colelitiasis, aunque puede variar desde ser completamente asintomática hasta sugerir una lesión maligna. El objetivo de este estudio fue revisar la afectación adenomiomatosa de la vesícula biliar y los conductos biliares intrahepáticos y extrahepáticos, así como su diagnóstico y tratamiento. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de 10 años de duración en los servicios de Cirugía Digestiva y Anatomía Patológica del Hospital Universitario San Cecilio en Granada, España. Se incluyeron todos los pacientes que presentaban afectación adenomiomatosa de la vesícula biliar y del sistema biliar intrahepático y extrahepático. Resultados, Entre los años 2000 y 2010, se identificaron 24 pacientes, 19 mujeres y 5 hombres, con adenomiomatosis de un total de 5.141 piezas quirúrgicas. Las manifestaciones clínicas fueron de colelitiasis en 20 (83,3 %) pacientes, de colecistitis en 2 (8,35 %) y de obstrucción (ictericia) en 2 (8,35 %), y correspondieron con los hallazgos histopatológicos: se encontraron 20 lesiones localizadas en el fondo de la vesícula, dos en el conducto cístico y dos en el colédoco distal. En la mayoría de los casos se practicó colecistectomía laparoscópica simple; los últimos dos se sometieron a duodenopancreatectomía cefálica u operación de Whipple, por sospecharse afectación maligna. Conclusión. Esta enfermedad puede presentarse con ausencia completa de síntomas, o con manifestaciones de colelitiasis, colecistitis o de síndrome colestásico. En los casos en que se sospeche una afectación maligna, lo adecuado es hacer un examen histopatológico intraoperatorio, antes de practicar cirugías complejas.

Introduction: Adenomyomatosis of the gallbladder and biliary ducts is an anatomic and medical entity of difficult diagnosis. It can be classified as generalized, segmentary or localized. Typical clinical presentation includes symptoms of cholelithiasis, but it can range from completely asymptomatic to suspicion of malignancy. The aim of this study was to review the gallbladder and intra and extrahepatic biliary ducts affectation by adenomyomatosis, its diagnosis and treatment. Patients and Method: Ten-year retrospective study, held at San Cecilio University Hospital's Digestive Surgery and Pathology Services in Granada, Spain. All patients with gallbladder and intra and extrahepatic biliary ducts adenomyomatosis were included. Results: 24 patients with adenomyomatosis were identified out of 5,141 surgical specimen in the ten-year period 2000-2010; 19 were female and five male. Twenty (83.3%) patients presented with symptoms of cholelithiasis, two (8.35%) with symptoms of cholecystitis, and two (8.35%) with obstructive signs (jaundice),all of which were consistent with the pathology findings: 20 lesions were located in the gallbladder fundus, two in the cystic duct, and two in the distal common bile duct. Laparoscopic cholecystectomy was performed in all but the last two cases, in which a cephalic pancreatico-duodenectomy, or Whipple procedure, was perfomed for suspected malignancy. Conclusion: This entity's clinical condition can present as totally asymptomatic, or with symptoms of cholelithiasis, cholecystitis, or cholestatic syndrome. When malignancy is suspected, intra-operative pathological confirmation is recommended before undertaking a complex surgical procedure.

Clinicopathologic analysis of 14 cases of atypical polypoid adenomyoma of endometrium with the emphasis on its cancerous transformation / 中华妇产科杂志

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.

A case of cystic adenomyoma of the uterus after complete abortion without transcervical curettage

We diagnosed a 2-cm, large cystic adenomyoma after complete abortion without transcervical curettage, based on symptoms of dysmenorrhea, time of onset, and sonographic findings. The cystic adenomyoma was treated successfully with laparoscopic mass excision.

Adenomiose / Adenomyosis

A adenomiose frequentemente teve papel pouco valorizado na etiologia de várias doenças ginecológicas, provavelmente devido a grande dificuldade diagnóstica. Ao longo dos anos, seu diagnóstico ocorria por suspeição ou por achado em peças cirúrgicas de histerectomias. Exames de imagem começaram a ajudar no diagnóstico precoce desta patologia, como ultrassonografia transvaginal, histerossonografia, elastossonografia e, principalmente, ressonância magnética, através da determinação da espessura da zona juncional. Outros exames, como tomografia computadorizada, biópsia miometrial e dosagem de CA-125, não demonstram a mesma acurácia. O tratamento, que até recentemente se restringia à histerectomia, começa a apresentar novas opções como os agonistas e antagonistas do GnRH, os contraceptivos contínuos, danazol, dispositivos intrauterinos medicados, inibidores de aromatase, além de procedimentos mais conservadores como a embolização da artéria uterina, a adenomiomectomia e a ressecção parcial de adenomiose combinada à oclusão da artéria uterina por via laparoscópica.

Heterotopia pancreática yeyuna yuxtahepática y en quiste de conducto colédoco / Jejunal juxtahepatic and common bile duct (ductus choledochus) cystic pancreatic heterotopia

Se exponen 3 casos con hallazgo incidental de páncreas heterotópico, en autopsia y 2 piezas quirúrgicas para hacer una breve revisión del tema. Casos: 1. Mujer de 53 años de edad fallecida por neumonía de focos múltiples. Durante el estudio post mortem se encontró, a nivel del segmento yeyunal, un nódulo constituido histológicamente por múltiples conductos con epitelio columnar y fibras anchas desorganizadas de músculo liso. 2. Preescolar varón de 2 años 11 meses de edad con diagnóstico de quiste de colédoco y resección del mismo. En uno de los cortes de pared se observó una banda de tejido que a la microscopía de luz correspondía a tejido pancreático sin alteraciones. 3. Escolar mujer de 6 años 10 meses de edad con diagnóstico de síndrome de Byler candidata a transplante hepático. Los cortes histológicos del explante en la región del hilio revelaron grupos multifocales de conductos y acinos pancreáticos sin presencia de islotes. Conclusión: La heterotopia pancreática es un hallazgo infrecuente que se puede observar a cualquier nivel del tracto gastrointestinal e inclusive fuera del mismo, por lo que la caracterización histopatológica de esta alteración permite distinguirla de otras lesiones. Pese a su conducta habitualmente benigna y asintomática, ocasionalmente puede dar origen a cuadros obstructivos, hemorrágicos, inflamatorios o neoplásicos.

We report three cases of pancreatic heterotopia incidentally found (one in autopsy and two in surgical pieces) with a brief review of the literature. Cases: 1. A fifty-three-year-old woman who died of bronchopneumonia. During post-mortem examination, a nodule (hystologically formed by multiple ducts lined by columnar epithelium and broad disarranged smooth muscle fibers) was found at the level of jejune. 2. 5-year, 11-month-old male with diagnosis ofcholedochal cyst. In the resected specimen, one of the mural slices showed a tissue stripe that under light-microscope examination corresponded to normal pancreatic tissue. 3. 6-year, 10-month-old female diagnosed with Byler syndrome who was recipient of liver transplant. Slices taken from the hilum in the resected specimen revealed multiple clusters of pancreatic acini and ducts without evidence of endocrine islets. Conclusion: Pancreatic heterotopia is an uncommon finding, which may be found at any level of the gastrointestinal tract, and even outside it. Histopathologic studies allow to distinguish this disorder from other lesions. Despite its commonly benign and asymptomatic behaviour, it may sometimes produce obstruction, hemorrhage, inflammation or neoplasms.

Analysis the related risk factors and comparison between adenomyosis and uterine myoma / 中国医师进修杂志

Objective To study the related risk factors and comparison between adenomyosis and uterine myoma in order to find the same and different ways of preventing adenomyosis and uterine myoma.Methods Clinical data of 200 cases of adenomyosis and 200 cases of uterine myoma were retrospectively analyzed.Results There was no significant difference in the incidence of different ages between adenomyosis and uterine myoma (P ＞ 0.05).There were significant differences in A blood type,family history,dysmenorrhea and using intrauterine device between adenomyosis and uterine myoma (85 cases vs.56 cases,9 cases vs.36 cases,163 cases vs.71 cases,104 cases vs.79 cases,P ＜ 0.05),but there was no significant difference in occupation,education,previous gynaecopathia inflammatory disease,age of menarche,menstrual cycle,menstruation,infertility,the first gestational age,parity,abortion numbers between adenomyosis and uterine myoma (P ＞ 0.05).Conclusions The adenomyosis and uterine myoma may be associated with the stimulation by high level of female hormone.Compared with uterine myoma,adenomyosis seems to be related to A blood type,dysmenorrhea and using intrauterine device.

Clinical, Pathological, and Immunohistochemical Features of Adenomyoma in the Ampulla of Vater / 대한소화기학회지

BACKGROUND/AIMS: Ampullary adenomyoma is a benign lesion whose malignant potential has yet to be confirmed. Despite its benign nature, adenomyoma is frequently misdiagnosed as a carcinoma or adenoma and is overtreated by extensive surgery. This study was performed to analyze the clinical, pathological, and immunohistochemical features of adenomyomas in the ampulla of Vater. METHODS: Nine cases of adenomyoma in the ampulla of Vater, diagnosed in Chungbuk National University Hospital between 2008 and 2011, were enrolled in this study. We reviewed the clinical data on the symptoms, laboratory data, and radiologic findings of the abdominal computed tomography and endoscopic retrograde cholangiopancreatography. For pathological analysis, all the slides were reviewed by one pathologist, and immunohistochemical stainings with antibodies against cytokeratin 7 (CK7), cytokeratin 20 (CK20), alpha-smooth muscle actin (alpha-SMA), and Ki-67 antigen were performed. RESULTS: All the cases were CK7 positive and CK20 negative. A strong cytoplasmic expression of alpha-SMA was confirmed in all cases. The Ki-67 index was less than 1% in eight cases and 5% in one case. Four cases underwent endoscopic papillectomy, and one case received surgical ampullectomy during colorectal cancer surgery. Five cases that underwent endoscopic or surgical treatment remained symptom-free for three years. Four cases that were closely observed with repeated endoscopic examinations exhibited no interval changes in the papillary lesions. CONCLUSIONS: Endoscopic biopsy and immunohistochemistry can aid in the diagnosis of ampullary adenomyomas. Endoscopic papillectomy or surgical ampullectomy is adequate for the treatment of symptomatic ampullary adenomyomas.

Extrapelvic Uterus-like Masses Presenting as Colonic Submucosal Tumor: A Case Study and Review of Literature

A uterus-like mass (ULM) is a central cavity lined by endometrial glands and stroma and surrounded by thick-walled smooth muscles. To date, 31 cases of ULM have been reported in the English literature. ULM typically presents as a single mass and is located in the pelvic cavity. We report here a very rare case of multiple extrapelvic ULMs involving the cecum, descending colon, and mesocolon. After extensive literature research, our case appears to be the first case of multiple ULMs found in extrapelvic sites and the first case of ULM in the colon. The present case suggests that ULM should be included in the differential diagnosis of colonic submucosal tumors in female patients with chronic abdominal pain or menstruation-associated symptoms.

The clinical value of ultrasound elastography in evaluating uterine leiomyomas and adenomyosis treated with percutaneous microwave ablation / 中华超声影像学杂志

ObjectiveTo study the clinical value of ultrasound elastography in evaluating the ablated zone and morphology of uterine leiomyoma and adenomyosis treated with percutaneous microwave ablation treatment(PMAT) under ultrasound guidance.MethodsEighteen patients were randomly chosen from 150 patients with symptoms uterine leiomyomas or adenomyosis who were treated with PMAT.Contrastenhanced Ultrasound(CEUS) and ultrasound elastography were performed before and immediately after PMAT.Compared with contrast enhanced MR were performed at 1 - 2 d after PMAT,the accuracy of ultrasound elastography and CEUS in evaluating the ablated range of PMA were analysed.Results Ultrasound elastography showed that the ablated zone was blue and the boundary with the surrounding tissues was clear.The ablated zone showed no enhancement with CEUS and enhanced MR.The mean diameter of the ablated zone in ultrasound elastography,CEUS,and contrast enhanced MR was (4.90 ±1.12)cm,(4.64 ± 0.93) cm,and (4.89 ± 1.02) cm,respectively.The diameter in ultrasound elastography was slightly larger than that in CEUS ( P =0.02) and had no statistical difference with that in contrast enhanced MR ( P =0.44).ConclusionsUltrasound elastography can accurately show the coagulation range immediately after PMAT and is supposed to be a method to evaluate the ablated zone noninvasively immediately after PMAT.