Atypical Polypoid Adenomyomas of Uterus: A Clinicopathologic Study of 2 Cases

Atypical polypoid Adenomyomas (APA) is a rare benign tumour in uterine. It is would distinguished from well-differentiated endometrial adenocarcinoma because of his histological features. We report 2 cases of 31-year-old and 33-year-old patient whose symptom were abnormal uterine bleeding. The mass was pedunculated with a narrow pedicle connecting to the pedunculated with a narrow pedicle connecting to the cervical;the other was in the uterine prolapse without pedicle. The surgical procedure was polypectomy only in all two patients with hysteroscopy. The histopathology showed the lesions were composed of a proliferation of irregular atypical endometrial glands separated by varying amounts of cellular smooth-muscle stroma. No mitotic activity was observed in the epithelial or mesenchymal elements in APA. The treatment of APA should depend on the age and reproductive desire of patient.

Gastric adenomyoma presenting as melena: A case report and literature review

Gastric adenomyoma (AM) is a rare benign tumor characterized by glandlike structures embedded within a smooth muscle stroma. We report a case of a 68yearold man with gastric AM admitted to our hospital for melana. Endoscopic examination revealed a gastric mass of about 4 cm in diameter, located in the antrum. Histologic examination of the excised specimen showed irregularly arranged glands and interlacing smooth muscle bundles surrounding the glandular elements. Although gastric AM is rare, it should be considered in differential diagnosis of extramucosal gastric tumor.

MRI and Transvaginal Ultrasound Findings of Atypical Polypoid Adenomyoma: A Case Report

Atypical polypoid adenomyoma(APA)is an uncommon type of polypoid characterized by fibroid stroma and endometrial glands.It occurs mostly in premenopausal women and rarely in postmenopausal women with irregular vaginal bleeding.In our current case,a 76-year-old woman presented with irregular vaginal bleeding.The final pathological diagnosis of the mass was APA.APA is not easy to diagnose before surgery.On the one hand,there was no obvious particularity in imaging features and clinical features,especially for uncomfortably identifying endometrial cancer.On the other hand,APA has a pedicle,attaching to any part of the uterine cavity,which can cause pseudocoel between the mass with the uterine cavity wall.So,when it comes to getting the pathological tissue in the absence of hysteroscopy,it is easy to access to the pseudocoel and obtain endometrial tissue rather than the pathological tissue of the mass.Therefore,preoperative imaging examination is of great significance diagnosis way of thinking to clinicians for APA.In the meantime,pathological tissue of APA can be obtained by hysteroscopy in visual conditions.

Atypical Polypoid Adenomyoma (APAM) of the Uterine: Relationship with Endometrial Cancer

Atypical polypoid adenomyoma (APAM) is a rare polypoid tumor that generally occurs in women of reproductive age who have abnormal genital bleeding. The tumor was reported as a new disease concept by Mazur in 1981. Pathologically, APAM consist of irregularly proliferated endometrial gland cells and interlacing bundles of smooth muscle cells within the stroma, and have a similar form to adenocarcinoma, adenofibroma, adenosarcoma, and carcinosarcoma. Therefore, differential diagnosis is required in many cases. APAM is pathologically classified as a benign lesion and clinically has a comparatively favorable outcome. However, treatment and follow-up observation should be performed carefully because recurrence and residual lesions occur in many patients after conservative treatment. Concomitant development of endometrial adenocarcinoma also occurs in many cases and it is difficult to differentiate this disease from APAM. Thus, diagnosis of APAM should be made carefully, particularly since the number of cases of endometrial adenocarcinoma has increased in recent years. Furthermore, APAM tends to develop during a woman’s reproductive years, and fertility sparing treatment should be considered. Here, we review the clinicopathological characteristics of APAM, including the difficulty of diagnosis as a benign or malignant uterine tumor, and we examine the relationship between APAM and endometrial cancer.

Asymptomatic gastric adenomyoma and heterotopic pancreas in a patient with pancreatic cancer: A case report and review of the literature

BACKGROUND Gastric adenomyoma(GA)is a rare submucosal benign neoplasm that occurs mostly in the gastric antrum and is often misdiagnosed.No standard treatment has been established for this disease in cases of malignancy.CASE SUMMARY A 75-year-old woman with a 10-year history of hypertension was admitted to the Emergency Department of our hospital complaining of paroxysmal exacerbation of acute abdominal pain for 1 d with no apparent cause.Enhanced computed tomography and magnetic resonance imaging indicated a mass in the caudal pancreas,cholecystitis,and cholecystic polypus.Gastrointestinal endoscopy showed a mass arising from the gastric antrum.Due to the imaging findings,pancreatic cancer(PC),gastric lesion,cholecystitis,and cholecystic polypus were our primary consideration.Radical pancreatectomy,splenectomy,and cholecystectomy were performed successfully,and the gastric tumor was locally resected.Postoperative paraffin specimens confirmed the diagnosis of caudal PC,GA,and heterotopic pancreas(HP).Unfortunately,the patient died 13 mo later due to PC metastases to the liver,lung,and adrenal glands.CONCLUSION GA is a rare benign disease,especially when occurring with HP.It may stem from the same origin as HP.This is the first case report to date of a patient suffering from the simultaneous occurrence of GA,HP,and PC.GA is a lesion that can mimic other benign or malignant gastrointestinal diseases;thus,a definitive diagnosis depends on postoperative pathological biopsy.Although GA and HP are both benign lesions,they should be resected because there is a chance of malignancy.Additional research should be conducted to better understand these submucosal lesions.

Adenomyoma of the small intestine

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.

Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature

BACKGROUND Adenomyomatous hyperplasia of the distal common bile duct(CBD)is very rare,with only scarce case reports in the literature.Diagnosis is usually based on imaging findings,and endoscopic biopsy is very difficult before operation.It is believed that adenomyomatous hyperplasia has little or no risk of malignant transformation.CASE SUMMARY A 68-year-old woman with abdominal pain in the right upper quadrant was referred to our hospital.Abdominal ultrasonography in the emergency ward revealed acute cholecystitis and dilated CBD.Laboratory findings showed elevated levels of transaminases,phosphatase,andγ-glutamyltranspeptidase.Pharmaceutical treatment for 3 d did not relieve the symptoms.Magnetic resonance cholangiopancreatography(MRCP)and computed tomography(CT)showed proximal bile duct dilatation but could not identify the cause.Endoscopic ultrasonography(EUS)demonstrated a mixed echogenic mass in the distal CBD.During surgery,a firm mass was found in the distal CBD and the Whipple procedure was performed with the initial concern of malignancy.Histology showed diffuse adenomyomatous hyperplasia.CONCLUSION EUS may be a useful choice to diagnose adenomyoma of the distal CBD before operation,especially in patients with ambiguous MRCP/CT findings.

Characteristics and efficacy of modified adenomyomectomy in the treatment of uterine adenomyoma

Background Adenomyoma is a very serious disease which influence the quality of life and leads to the infertility, and hysterectomy at the end. Unfortunetly, we still have no effective way to treat this kind of diseases. This study was aimed to evaluate the efficacy and surgical characteristics of modified adenomyomectomy. Methods This is a retrospective study and the subjects were collected in the past 5 years. We divided the subjects by the two different surgical procedures. Cases of adenomyoma patients who underwent conservative surgery, modified adenomyomectomy or wedge resection of the adenomyoma lesion were distributed to two groups retrospectively. Surgical characteristics, symptom relief, and recurrence were analysed in each group. Results General characteristics, including operation time, blood loss, and postoperative complication were similar in both groups. In the modified adenomyometomy group, the median follow-up time was 27.6 months and the rate of relief of dysmenorrhea and menorrhagia symptoms were 91.2% and 40.0%, respectively. In the wedge resection group, the rate of reliefe of dysmenorrhea and menorrhagia symptoms were 88.9% and 50.0%, respectively. Patients in both groups had statistically significant symptom relief, but there was no statistical difference between them. During the following time, ultrasonography relapse rate in modified modified adenomyomectomy group is significantly lower than the wedge resection group 15.0% vs. 69.2% （P 〈0.001）. The relapse rate, in terms of symptoms, was 5.0% in the modified adenomyomectomy group, which was similar to the relapse rate in the wedge resection group. In terms of reproductive outcome, 33.3% of the patients with infertility complications in the modified adenomyomectomy group became pregnant. Among them, the rate of pregnancy by assisted reproductive techniques was 45.5%, which was significantly higher than the rate of natural pregnancy, 23.1% （P =0.039）. Conclusion Modified adenomyomectomy appears to be a safe and effective operative method that shows advantages in reducing the rate of relapse after surgery.

Gonadotropin releasing hormone agonists and laparoscopy in the treatment of adenomyosis with infertility

To study the role and value of gonadotropin releasing hormone agonists (GnRH a) and laparoscopy for the treatment of adenomyosis with infertility Methods Four cases were seen with adenomyosis and infertility, 3 of these cases also presented local adenomyomata in the posterior uterine wall GnRH a Triptorelin (decapeptyl) or Goserelin (Zoladex) therapy was instituted for six months before laqaroscopic surgery for coexisting pelvic pathologic infertility factors in one case and after laparoscopic surgery in three cases Results All cases remained amenorrheic during GnRH a therapy After the GnRH a therapy, all enlarged uterus (7-10 weeks gestation size) all decreased to normal or near normal size; menstruation returned in 80-90 days and three cases conceived within four menstrual periods after cessation of treatment In the 4 cases one pregnancy resulted in the birth of a healthy 3150?g male newborn at 38 weeks gestation by cesarean section; one pregnancy was terminated after adenomyomectomy by emergency cesarean section at 30 weeks gestation because of threatened rupture of uterus; one case was then normal at 28 weeks pregnancy; the last case had 2 resumptive menstrual periods and was still being followed up Conclusions GnRH a is markedly efficient in reducing adenomyotic uterine size, facilitates uterine or endometrial receptivity for embryos and enhances uterine ability to maintain pregnancy For adenomyomata associated with infertility, GnRH a instead of surgical removal of lesions, which are deep in the myometrium, may avoid uterine rupture when pregnancy occurs For infertility, GnRH a treatment before laparoscopic surgery greatly decreases surgical difficulties and blood loss in certain cases

Effect of preopera tivetranscatheter arterial chemoembolization on tumor cell activity in hepatocellular carcinoma

To study the role and value of gonadotropin releasing hormone agonists (GnRH a) and laparoscopy for the treatment of adenomyosis with infertility Methods Four cases were seen with adenomyosis and infertility, 3 of these cases also presented local adenomyomata in the posterior uterine wall GnRH a Triptorelin (decapeptyl) or Goserelin (Zoladex) therapy was instituted for six months before laqaroscopic surgery for coexisting pelvic pathologic infertility factors in one case and after laparoscopic surgery in three cases Results All cases remained amenorrheic during GnRH a therapy After the GnRH a therapy, all enlarged uterus (7-10 weeks gestation size) all decreased to normal or near normal size; menstruation returned in 80-90 days and three cases conceived within four menstrual periods after cessation of treatment In the 4 cases one pregnancy resulted in the birth of a healthy 3150?g male newborn at 38 weeks gestation by cesarean section; one pregnancy was terminated after adenomyomectomy by emergency cesarean section at 30 weeks gestation because of threatened rupture of uterus; one case was then normal at 28 weeks pregnancy; the last case had 2 resumptive menstrual periods and was still being followed up Conclusions GnRH a is markedly efficient in reducing adenomyotic uterine size, facilitates uterine or endometrial receptivity for embryos and enhances uterine ability to maintain pregnancy For adenomyomata associated with infertility, GnRH a instead of surgical removal of lesions, which are deep in the myometrium, may avoid uterine rupture when pregnancy occurs For infertility, GnRH a treatment before laparoscopic surgery greatly decreases surgical difficulties and blood loss in certain cases

A clinicopathological study of 39 cases of atypical polypoid adenomyoma of the uterus

Objective:To clarify the clinical and pathological characteristics of atypical polypoid adenomyoma(APA)in order to improve the criteria used to diagnose and treat this disease.Study design:In 39 cases of APA,retrospective analysis was performed of theclinical data,pathological characteristics,and the follow-up findings in patients admitted to the Peking University People's Hospital from 2007 to 2019.Results:The median age was 39.6 years(range 24–60 years).Thirty seven patients were premenopausal(i.e.94.9%)and eighteen patients were nullipara(i.e.46.2%).Abnormal uterine bleeding was the most common presenting symptom.Hysteroscopic transcervical resection(i.e.TCR)identified lesions in 35 cases whereas:(a)hysterectomy identified them in 3 cases;(b)dilatation and curettage(D&C)identified them in 1 case.Immunohistochemical analysis was performed on 24 samples.In the glandular component,hormone receptors were positively expressed.In all cases,Ki67 expression was detectable in approximately 50%of the cases.In those samples,its presence was definitive in eighteen of the nineteen cases(94.7%,18/19),p53 positive expression was present in most cases(68.8%,11/16),and PTEN positive expression was detected in 40%(4/10).Stroma immunophenotype expression was exhibited as follows:(a)CD10-(12/12),Desminþ(6/7);(b)Vimentinþ(4/4);(c)α-SMAþ(3/3)and;d p16 positve staining in of 80%(4/5).The concurrent amount of atypical endometrial hyperplasia with atypical polypoid adenomyoma was 23.1%(9/39),while its concurrent level of endometrial carcinoma with atypical polypoid adenomyoma was 7.7%(3/39).Fertility preserving treatments were performed in 20 patients with strong childbearing desires.Their pregnancy success was 15%(3/20)and the live birth frequency was 10%(2/10).Follow-up findings were available in 36 cases(92.3%)with a medial follow-up of 48.1 months(range 4–122 months).Its pathological recurrence and frequency of progression into endometrial carcinoma were both 5%(1/20).One case died of another type of malignancy,while the other patients were alive.Conclusions:APA occurs mostly during the years of a women's reproductive period.Its diagnosis is based on the analysis of pathological and immunohistochemical findings.Individuals diagnosed with APA are at risk to coexist with endometrial carcinoma and atypical endometrial hyperplasia.For those individuals who desire retaining fertility,the treatment strategy involves performing TCR completely remove the lesions and close follow-up for surveillance of possible progressive APA recurrence.For those individuals who have no fertility desire,hysterectomy may be a preferred option.

Evaluation Value of Intravoxel Incoherent Motion Diffusion-Weighted Imaging on Early Efficacy of Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation for Uterine Adenomyoma

To investigate the evaluation value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)on the early efficacy of magnetic resonance-guided high-intensity focused ultrasound(MRgFUS)ablation for uterine adenomyoma.The clinical and magnetic resonance imaging(MRI)data of 36 patients with uterine adenomyoma before and after MRgFUS treatment in our hospital from January 2018 to December 2018 were retrospectively analyzed.All the 36 patients underwent MRI examination one day before operation and immediately after operation using GE Discovery MR7503.0T MRI,including conventional sequences(T1WI,T2WI,and T2 fat suppression sequences)plain scan,IVIM-DWI sequences with 9 b values,and contrast enhanced-MRI sequences.The IVIM-DWI quantitative parameters(true diffusion coefficient D,perfusion related diffusion coefficient D*,and perfusion fraction f)of double-exponential model were obtained by using GE ADW 4.7 functool,a postprocessor.SPSS 24.0 software was used to analyze the difference in parameter between the ablation and non-ablation areas of uterine adenomyoma.DWI signal in the ablation area of uterine adenomyoma was increased,and manifested as heterogeneous diffuse high signal,with low central signal and high edge signal.Values of D,D*and f in the ablation area of uterine adenomyoma were significantly lower than those in the non-ablation area,and there was statistical difference between the two(P<0.05).The areas under receiver operating characteristic(ROC)curve of D,D*and f values in the ablation area of uterine adenomyoma were 0.854,0.898 and 0.924,respectively;the optimal thresholds for the diagnosis of ablation area of uterine adenomyoma were 0.81×10−3 mm2/s,4.99×10−3 mm2/s and 0.24,respectively;the diagnostic sensitivity was 80.6%,72.2%and 94.4%,respectively;and the specificity was 91.7%,97.2%and 94.4%,respectively.IVIM-DWI has a certain clinical value in the evaluation on early efficacy of MRgFUS ablation of uterine adenomyosis.