Weng Chong-You, Lee Cheng-Hung
Division of Surgical Intensive Care Unit, Buddhist Tzu Chi Medical Foundation Dalin Tzu Chi Hospital, Chia Yi, Taiwan.
Department of General Surgery, Buddhist Tzu Chi Medical Foundation Dalin Tzu Chi Hospital, Chia Yi, Taiwan.
Medicine (Baltimore). 2025 Feb 28;104(9):e41649. doi: 10.1097/MD.0000000000041649.
Adenomyomatosis is a rare benign condition characterized by epithelial proliferation and diverticular formation in the gastrointestinal tract, most commonly affecting the gallbladder. Its occurrence in the bile duct is uncommon but significant, as it can cause biliary obstruction, cholestasis, and abdominal pain-symptoms that closely mimic early-stage cholangiocarcinoma. This overlap creates diagnostic challenges and increases the risk of misdiagnosis and overtreatment, making accurate identification essential.
A 54-year-old woman presented with persistent epigastric dull pain. Imaging studies revealed a dilated common bile duct (CBD), raising concerns about biliary pathology.
Abdominal computed tomography demonstrated a contrast-enhanced 1.6 cm tumor-like mass in the distal CBD, leading to a presumptive diagnosis of malignancy. Laboratory findings showed an elevated γ-glutamyl transferase level, while other tumor markers were within normal ranges.
Due to the high suspicion of malignancy, the patient underwent a Whipple procedure for both diagnostic and therapeutic purposes.
Histological examination of the resected specimen surprisingly revealed adenomyomatosis of the CBD, confirming a benign diagnosis. The patient had an uneventful postoperative recovery and was discharged 19 days after surgery.
This case highlights the diagnostic challenge posed by adenomyomatosis of the distal CBD, as its radiological appearance can closely resemble malignancy. Clinicians should be aware of this rare entity to avoid unnecessary aggressive surgical interventions.
腺肌瘤病是一种罕见的良性疾病，其特征为胃肠道上皮细胞增生和憩室形成，最常累及胆囊。它在胆管中发生虽不常见但很重要，因为它可导致胆道梗阻、胆汁淤积和腹痛，这些症状与早期胆管癌极为相似。这种重叠造成了诊断上的挑战，增加了误诊和过度治疗的风险，因此准确识别至关重要。
一名54岁女性因上腹部持续钝痛就诊。影像学检查显示胆总管扩张，引发了对胆道病变的担忧。
腹部计算机断层扫描显示胆总管远端有一个1.6厘米的造影剂增强的肿瘤样肿块，初步诊断为恶性肿瘤。实验室检查结果显示γ-谷氨酰转移酶水平升高，而其他肿瘤标志物在正常范围内。
由于高度怀疑为恶性肿瘤，患者接受了惠普尔手术，兼具诊断和治疗目的。
切除标本的组织学检查令人惊讶地显示为胆总管腺肌瘤病，确诊为良性疾病。患者术后恢复顺利，术后19天出院。
该病例凸显了胆总管远端腺肌瘤病所带来的诊断挑战，因为其影像学表现可能与恶性肿瘤极为相似。临床医生应了解这种罕见疾病，以避免不必要的激进手术干预。
