Benign polypoid adenomyomatous endometrium associated with hpt-JT syndrome: a case report.

Hyperparathyroidism-jaw tumor (HPT-JT) is an autosomal dominant disorder responsible for benign and/or malignant tumors. Affected women often present life-threatening menorrhagia that leads to the identification of uterine tumors, and experience miscarriages and infertility. Overall though, fewer data concerning gynecological pathologies related to HPT-JT syndrome are available. We report the case of a 32-year-old woman with HPT-JT syndrome, referred for recurrent vaginal bleeding, with a history of repeated endometrial polyps and infertility. We also review the literature that explores medical options for these women.

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.

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.

Polycystic ovary syndrome and increased polyp numbers as risk factors for malignant transformation of endometrial polyps in premenopausal women.

OBJECTIVE: To determine the pre-malignant and malignant potential of endometrial polyps and to assess whether different clinical parameters are associated with malignancy in the polyps of premenopausal women. METHODS: The clinical records of operative office hysteroscopic and resectoscopic procedures for endometrial polyps in 417 premenopausal women who attended Baskent University were examined over a retrospective period of 30 months. Only premenopausal patients were included in the study. RESULTS: In 97.8% of women, histology showed benign endometrial pathology. In 2.2% of women, pre-malignant or malignant conditions were found in the polyp. Polycystic ovary syndrome (PCOS) and the presence of 2 or more polyps were associated with significant pre-malignant or malignant changes. CONCLUSION: The presence of irregular vaginal bleeding was not a predictor of malignancy in the polyp. Premenopausal women with PCOS and those with 2 or more polyps had an increased prevalence of polyp malignancy. These groups of patients, whether symptomatic or not, should be evaluated by hysteroscopic resection of the polyps.

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.

[Gallbladder adenomyomatosis].

THE AIM: to familiarize with the main clinical aspects of the adenomyomatosis gallbladder. Recent literature data show that adenomyomatosis of the gallbladder is not a rare disease and its frequency in cholecystectomy is 2-8.7%. It is more common after the age of 35-40 years and among women. Course of the disease is complicated by cholecystolithiasis, and localization in the bottom of the gall bladder-malignization. The main method of diagnosis is ultrasonography. For the differential diagnosis of cancer of the gall bladder used under the MRIs. Cholecystectomy is indicated for complications of cholecystolithiasis and suspected malignancy in the gallbladder.

Ovarian adenomyoma following gonadotrophin treatment for infertility.

An ovarian adenomyoma developed in a 38-year-old infertile patient following treatment with exogenous gonadotrophins. Laparoscopic excision was performed. Histological examination showed thick muscular bundles resembling myometrium lined with endometrial glands and stroma. Gonadotrophins might be involved in the pathogenesis of extrauterine adenomyoma.

Iatrogenic peritoneal adenomyoma after laparoscopic subtotal hysterectomy and uterine morcellation.

Five years after laparoscopic subtotal hysterectomy and morcellation, pelvic magnetic resonance imaging demonstrated the presence of an irregular and heterogeneous pelvic mass measuring 40 x 40 x 30 mm. Histologic examination confirmed smooth muscle hyperplasia infiltrated by numerous endometrial glands (adenomyosis).

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.

Anomalous pancreaticobiliary ductal union--an etiologic association of gallbladder cancer and adenomyomatosis.

BACKGROUND/AIMS: Anomalous pancreaticobiliary ductal union (APBDU) has been proposed as a risk factor of gallbladder cancer. To clarify the frequency and the subtype distribution of APBDU in patients with gallbladder cancer and adenomyomatosis, a retrospective study was performed. METHODOLOGY: The radiograms of endoscopic retrograde cholangiopancreaticography of 680 patients with well-documented biliary and pancreatic ducts from April 1992 to November 1996 were reviewed. The length of the common channel and insertion of the pancreatic duct and the bile duct were identified and recorded. RESULTS: Gallbladder cancer and adenomyomatosis were identified in 8 and 12 patients, respectively. Patients with gallbladder cancer were significantly older (mean age: 66.5 years, p<0.01) than those with gallbladder adenomyomatosis (mean age: 42.7 years). APBDU was noted in 59 (8.7%) of 680 cases with complete pancreaticobiliary radiograms. Among them, 5 of 8 patients with gallbladder cancer coexisted with APBDU. Four (80%) belonged to the P-B type. Six of 12 patients with gallbladder adenomyomatosis had APBDU. Five (83.3%) belonged to P-B type. CONCLUSIONS: Patients with gallbladder cancer and adenomyomatosis were frequently associated with APBDU. The close relationship and similar distribution of the P-B type of APBDU in both diseases suggest an etiologic association in various gallbladder diseases.

Cowden's disease with extensive gastrointestinal polyposis.

Cowden's disease, or multiple hamartoma syndrome, is a rare condition classified recently as a hereditary preneoplastic syndrome. Multiple orocutaneous hamartomas are associated with involvement of other organ systems, including fibrocystic breast disease and breast carcinoma, goiter, thyroid cancer, gastrointestinal polyps, and endometrial carcinoma. We describe a patient with Cowden's disease who underwent extensive gastroenterological work-up and review other cases in the literature.