Takahashi Yoshihisa, Fukusato Toshio
Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
World J Gastrointest Pathophysiol. 2011 Dec 15;2(6):88-92. doi: 10.4291/wjgp.v2.i6.88.
Adenomyoma of the gastrointestinal tract is a rare benign tumor-like lesion. The small intestine is the second most frequent location, usually in the periampullary area, but the lesion also occurs in the jejunum and ileum. While adenomyoma of the Vaterian system is primarily diagnosed in adults, more than half of reported cases of jejunal and ileal adenomyoma have been diagnosed in pediatric patients. Adenomyoma of the periampullary area usually presents with biliary obstruction or abdominal pain, whereas jejunal and ileal adenomyoma usually presents with intussusception or is incidentally discovered during surgery or autopsy. Since endoscopic and radiological examination yields uncharacteristic findings, histopathological evaluation is important in adenomyoma diagnosis. Pathologically, adenomyoma consists of glandular structures of various sizes and interlacing smooth muscle bundles that surround the glandular elements. The pathogenesis of adenomyoma is generally considered to be either a form of hamartoma or a pancreatic heterotopia. Although limited resection is considered the most effective treatment, pancreaticoduodenectomy is often performed when the lesion occurs in the periampullary area due to preoperative misdiagnosis as a carcinoma. It is, therefore, important that clinicians and pathologists maintain current knowledge of the disease to avoid inaccurate diagnosis, which could lead to unnecessary surgery.
胃肠道腺肌瘤是一种罕见的良性肿瘤样病变。小肠是第二常见的发病部位，通常位于壶腹周围区域，但该病变也可发生于空肠和回肠。虽然 Vaterian 系统腺肌瘤主要在成人中诊断，但超过半数的空肠和回肠腺肌瘤报告病例是在儿科患者中诊断出来的。壶腹周围区域的腺肌瘤通常表现为胆管梗阻或腹痛，而空肠和回肠腺肌瘤通常表现为肠套叠，或在手术或尸检时偶然发现。由于内镜和放射学检查结果不典型，组织病理学评估对腺肌瘤的诊断很重要。在病理上，腺肌瘤由大小各异的腺管结构和围绕腺管成分的交错平滑肌束组成。腺肌瘤的发病机制一般被认为是错构瘤的一种形式或胰腺异位。虽然局部切除被认为是最有效的治疗方法，但当病变发生在壶腹周围区域时，由于术前误诊为癌，常行胰十二指肠切除术。因此，临床医生和病理学家了解该疾病的最新知识很重要，以避免可能导致不必要手术的不准确诊断。
