Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
Medicine (Baltimore). 2023 Jun 16;102(24):e34080. doi: 10.1097/MD.0000000000034080.
Adenomyoma is a rare reactive, hamartomatous benign tumor-like lesion. Although adenomyoma can occur anywhere in the gastrointestinal tract, including the gallbladder, stomach, duodenum, and jejunum, it is very rarely observed in the extrahepatic bile duct and ampulla of Vater (AOV). The preoperative accurate diagnosis of adenomyoma of the Vaterian system, including the AOV and common bile duct, is significant to appropriate patient management. However, discriminating between benign and malignancy is highly challenging. Patients are frequently mistaken as having periampullary malignancy, thereby leading to unnecessary extensive surgical resection with a high risk of complications.
A 47-year-old woman visited a local hospital owing to epigastric and right upper-quadrant abdominal pain for 2 days.
Abdominal ultrasonography performed in the local hospital revealed suspicious of a distal common bile duct malignancy. She was transferred to our hospital for further evaluation and management.
After consulting with the patient, a multidisciplinary team, including a gastroenterologist, finally decided to perform surgery under the impression of an ampullary malignancy, and pylorus-preserving pancreatoduodenectomy was performed without any complications. She was histopathologically diagnosed with an adenomyoma of the AOV.
At the 5-year follow-up, she was well and did not develop further symptoms or complications.
Although adenomyoma is very rare, it should be included in the differential diagnosis of mass-like lesions of the AOV to avoid unnecessary surgeries.
腺肌瘤是一种罕见的反应性、错构瘤样良性肿瘤样病变。尽管腺肌瘤可发生于胃肠道的任何部位，包括胆囊、胃、十二指肠和空肠，但在肝外胆管和壶腹（ Vater ）非常罕见。术前准确诊断 Vater 系统（包括 Vater 壶腹和胆总管）的腺肌瘤，对于患者的适当管理非常重要。然而，鉴别良恶性极具挑战性。患者常被误诊为壶腹周围恶性肿瘤，从而导致不必要的广泛手术切除，并发症风险高。
一位 47 岁女性因上腹痛和右上腹痛 2 天就诊于当地医院。
当地医院进行的腹部超声检查提示胆总管下段恶性肿瘤可疑。她被转至我院进一步评估和治疗。
经与患者协商，包括消化科医生在内的多学科团队最终决定根据壶腹恶性肿瘤的印象进行手术，并进行保留幽门的胰十二指肠切除术，无任何并发症。她的组织病理学诊断为 Vater 壶腹腺肌瘤。
在 5 年的随访中，她恢复良好，未出现进一步的症状或并发症。
尽管腺肌瘤非常罕见，但应将其纳入 Vater 壶腹肿块样病变的鉴别诊断中，以避免不必要的手术。
