Department of Human Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
J Hepatobiliary Pancreat Sci. 2010 May;17(3):275-83. doi: 10.1007/s00534-009-0176-5. Epub 2009 Sep 26.
BACKGROUND/PURPOSE: Benign tumors and tumor-like conditions in the ampullary area are uncommon, and there are extremely rare cases of adenomyoma (AM) and adenomyomatous hyperplasia (AMH). Surgical treatment is necessary if these lesions cause biliary obstruction. In addition, the differential diagnosis of AM and AMH from carcinoma is often difficult by standard endoscopic biopsy and cytopathological analysis that may show differential findings, resulting in unnecessary surgeries sometimes being performed.
Immunohistochemical (IHC) analysis of periampullary AM and AMH was performed.
For both types of lesions, epithelial glandular cells (EGCs) showed diffuse expression of MUC6 and focal expression of HIK1083, mainly in the inner region, and focal expression of MUC5AC, mainly at the surface. The EGCs showed no expression of MUC1 or MUC4, both of which were identified as malignant tumor markers in our previous series of mucin expression studies in pancreatobiliary tumors. The expression of CK7, which was diffusely positive in normal periampullary mucosa, was decreased in the EGCs of AM and AMH.
A combined evaluation of IHC findings may be effective in the detection of AM and AMH, and also in distinguishing benign periampullary lesions, such as AM and AMH, from ampulla of Vater adenocarcinoma, thus avoiding excessive surgery.
背景/目的：壶腹部区域的良性肿瘤和肿瘤样病变并不常见，而腺肌瘤（AM）和腺肌瘤样增生（AMH）极为罕见。如果这些病变引起胆道阻塞，则需要进行手术治疗。此外，通过标准的内镜活检和细胞病理学分析对 AM 和 AMH 与癌的鉴别诊断常常很困难，有时可能会出现不同的发现，从而导致不必要的手术。
对壶腹周围 AM 和 AMH 进行了免疫组织化学（IHC）分析。
对于这两种病变类型，上皮腺体细胞（EGC）均表现出 MUC6 的弥漫性表达和 HIK1083 的局灶性表达，主要位于内区，并且 MUC5AC 的局灶性表达，主要位于表面。EGC 不表达 MUC1 或 MUC4，这两种物质在我们之前的胰胆管肿瘤黏蛋白表达研究系列中被鉴定为恶性肿瘤标志物。在正常壶腹周围黏膜中弥漫阳性的 CK7 在 AM 和 AMH 的 EGC 中减少。
联合评估 IHC 结果可能有助于检测 AM 和 AMH，并有助于鉴别良性壶腹周围病变，例如 AM 和 AMH，与 Vater 壶腹腺癌，从而避免过度手术。
