Adenomyomatous Hyperplasia Research Articles

Bile ductal mucosal dysplasia is a possible risk factor for adenocarcinoma in patients with adenomyomatous hyperplasia of the Vaterian system: a single-centre study from China

BackgroundThe relationship between adenomyomatous hyperplasia of the Vaterian system(AV) and cancer is unclear, some reports suggest that AV is often combined with mucosal glandular dysplasia, but it is not clear whether mucosal glandular dysplasia is a risk factor for carcinogenesis of AV. The aim of this study was to retrospective analysis of role of ductal glandular dysplasia as a risk factor in the development of carcinoma in AV.MethodsA total of 328 cases who underwent surgery with a final pathological diagnosis of adenomyomatous hyperplasia (AH) in the Chinese PLA General Hospital in BeiJing, China, between January 2005 and December 2021 were retrospectively collected. There were Seventeen cases(5%) in which the lesions were located in the common bile duct as well as the ampulla of Vater, and their clinical (age, sex, etc.), imaging (cholelithiasis, etc.) and pathological data (mucosal glandular dysplasia, etc.) were collected. Clinical data and pathological features of AV with or without mucosal glandular dysplasia were analyzed.ResultsThere were 17 out of 328 cases of AH occurring in the Vaterian system (5%). Three of seventeen AV cases were associated with carcinoma (18%). Of three cases, two (12%) with the tumor lesions in the mucosal glands adjacent to the AH (biliary tract cancer and ampullary cancer), and one (6%) with carcinoma developed from AH itself in the ampulla of Vater. All carcinomas had adenomyomatous hyperplasia with nearby mucosal glandular dysplasia (MGD). The percentage of BTC or AC was higher in patients with concurrent AH and MGD compared to AH patients without MGD. The results show tendency toward statistical significance (P = 0.082). This difference was more obvious among AH with severe dysplasia compared to adenomyomatous hyperplasia with mild-moderate dysplasia (P = 0.018).ConclusionThis study is the first to find that AV is associated with biliary tract cancer and ampullary cancer. In AV, the mucosal glandular dysplasia may be a risk factor for the development of malignancy. The underlying mechanism for carcinogenesis of AV could be AH itself or its secretions stimulating mucosal glands hyperplasia, then mucosal glands dysplasia. AV may be a precancerous lesion.

Chronic Cholecystitis with Cholelithiasis with Gall Bladder Adenomyomatous Hyperplasia in a Young Female - A Case Report

A thirty-year-old female presented to the Surgery outpatient department of Shri Ram Care Hospital, Bilaspur, Chhattisgarh, with complains of pain in whole abdomen with abdominal distention, nausea, anorexia, dyspepsia and constipation off and on for the last twenty days. There was no history of jaundice in the past. There were no bowel / bladder complaints. On examination, pallor was present. Per abdomen palpation revealed splenomegaly. She was evaluated completely; clinically, radiologically and by routine investigations. She was found to be anaemic (her haemoglobin level was 5.8 gm/dl) and her ultrasound abdomen revealed multiple gall bladder calculi with splenomegaly. She was admitted and a laparoscopic or if needed, an open cholecystectomy was planned after three units of blood transfusion.
 She underwent the procedure well at Shri Ram Care Hospital and her cholecystectomy specimen was sent to Anushka Diagnostics, Bilaspur, for histopathological evaluation.

Differences in SUV39H1 and Androgen Receptor Distribution in Adenomyomatous Hyperplasia and Prostatic Adenocarcinoma

Androgen receptor (AR) contributes to the growth of both early- and late-stage prostate cancer. Overexpression of suppressor of variegation 3-9 homolog 1 (SUV39H1) increases migration of prostate cancer cells, while depletion of SUV39H1 suppresses migration of prostate cancer cells. In this study, the aim was to show the relationships of AR and SUV39H1 with adenomyomatous hyperplasia (AH) and prostate adenocarcinoma (PCa). 70 AH and 70 PCa preparations in Pathology Department from 2013 to 16 were retrospectively investigated. Samples with immunohistochemical staining for AR and SUV39H1 were evaluated with a light microscope. After pathologic investigation of samples, AR and SUV39H1 expressions were scored. The changes in the frequencies of the obtained scores in the AH and PCa groups were analyzed statistically. AR expression was observed to be greater in AH compared to PCa. This difference was found to be statistically significant (p = 0.003). SUV39H1 expression was identified to be greater in PCa compared to AH and this showed statistical significance (p = 0.031). PCa samples were identified to have nearly 1.5 times more SUV39H1 mild staining compared to AH samples and this increase was two times for SUV39H1 strong staining. In our study, AR expression was greater in AH compared to PCa samples. This situation is inverse to the known mechanism and cannot be clearly explained. It needs to be supported with large series and other prognostic parameters. This study observed increased SUV39H1 values in PCa compared to AH and from this aspect, it may be considered an important poor prognosis parameter.

Фенотипическая трансформация гладких миоцитов стенки желчного пузыря при развитии некалькулезного холецистита

The aim of the study was to analyse ultrastructural changes in the smooth muscle tissue of different gallbladder sections during the development of experimental acalculous cholecystitis. Materials and methods. The research was performed on 20 guinea pigs. The duration of the experiment ranged from 4 to 15 days. Each experimental and control group included 5 animals. A standard model of chronic acalculous cholecystitis was used, in which ligation of the proximal part of the common bile duct is accompanied by inflammation and impaired gallbladder motility. Results. In guinea pigs with cholecystitis, on day 15 of the experiment using electron microscopic examination we revealed cells in the smooth muscle tissue that retain a well-structured contractile apparatus, represented by separate thin bundles of myofilaments, and a developed synthetic apparatus. The ultrastructural organization of this type of cells is quite characteristic of myofibroblasts. Studying the modulation of gallbladder smooth muscle cells in an experiment, we need to take into account that in the conditions of inflammation and impaired gallbladder motility, during the restructuring of the intercellular matrix, myofibroblasts can appear, causing the development of sclerotic processes in the organ wall due to their ability to express high levels of collagen and glycosaminoglycans, as well as numerous other extracellular matrix molecules and fibrogenic cytokines. The research showed that adenomyomatous hyperplasia of the gallbladder wall is accompanied by proliferation of myofibroblasts and smooth muscle cells. Thus, impaired stromal-epithelial interactions can be assumed to underlie the pathology in adenomyomatous hyperplasia of the gallbladder.

Primary Prostatic Tuberculosis: A Rare Entity

Objectives: To clarify the clinical, histological and therapeutic features of prostatic tuberculosis. Methods: We conducted a single-centre retrospective descriptive study of all patients presenting with prostatic tuberculosis between January 2002 and December 2020. Patients who were lost to follow-up, could not be reached by telephone or whose records were not usable were excluded from this study. Results: 240 patients were treated for urogenital tuberculosis, including 13 for isolated prostatic tuberculosis. The average age of the patients was 75 years. None of our patients had a history of tuberculosis. The average of international prostate symptom score (IPSS) was 27. Lower urinary tract symptoms in the filling phase were predominant. The digital rectal examination was suspicious in only one patient. The mean preoperative PSA was 9.24 ng/ml. 46.15% of patients underwent transurethral resection of the prostate and 53.85% underwent ultrasound-guided prostate biopsy. Histological examination showed epithelioid gigantocellular granuloma with isolated caseous necrosis in 61.53% of patients and associated adenomyomatous hyperplasia in 38.47% of patients. Antituberculosis treatment was given for 6 months. The average of follow up was 15 months. All patients reported an improvement in clinical signs with a mean post operative IPSS score of 17 and a normalisation of PSA levels. Conclusion: Isolated prostatic tuberculosis is a rare entity, it can simulate a cancer. In front of the symptoms of the lower urinary tract, the clinicians must think of it especially in the developing countries where tuberculosis still prevails in an endemic state.

Adenomyomatous Hyperplasia of Ampulla of Vater and a Concomitant Renal Tumor: A Case Report

Adenomyomatous hyperplasia is an extremely rare lesion encountered in the ampulla of Vater. Less than 50 cases have been described, most of them with clinical consequences of biliary obstruction, misdiagnosing it as a malignancy. The authors present a concomitant case with a renal tumor, its diagnosis, management, and clinical relevance, as well as a brief revision of the literature. Ampullar and renal tumors were found in a 74-year-old female, in the imagiologic study of a low back pain, in the emergency department. Both were considered malign after further study, and pancreatoduodenectomy with partial nephrectomy was proposed. There is no accurate diagnostic tool to differentiate the benign nature of adenomyomatous hyperplasia and extensive operations are often performed. As an incidental finding in the study of another tumor, this case raises the concern about which and how to treat both tumors, taking into account the morbidity of the respective interventions.

Morphological and immunophenotypical analysis of the spindle cell component in adenomyomatous hyperplasia of the gallbladder.

SummaryBackgroundAdenomyomatous hyperplasia (AMH) of the gallbladder, reported in 1-8.7% of cholecystectomies, consists of cystically dilated sinuses/glands with a surrounding spindle cell proliferation which is thought to be composed of smooth muscle cells. Myofibroblasts are contractile cells that secrete a variety of biochemical modulators causing a “field-effect”. Myofibroblasts can be immunohistochemically distinguished from smooth muscle cells by their desmin negativity.MethodsEighteen cases of AMH and five cases each of chronic follicular cholecystitis, chronic cholecystitis, gallbladder carcinoma and 10 colonic diverticular disease were stained with actin and desmin. The percentage of myofibroblasts was estimated by the difference between actin and desmin staining in the same field. Statistical anlysis was performed using SPSS 22.0.ResultsThe percentage of actin staining was significantly higher in AMH and gallbladder carcinoma compared to chronic follicular and chronic cholecystitis (p = 0.04). The percentage of desmin staining did not show any significant difference between the four groups. The estimated myofibroblastic population was significantly higher in AMH when compared to chronic follicular and chronic cholecystitis (p = 0.005).ConclusionThe spindle cell proliferation around cystically dilated glands in AMH is composed predominantly of myofibroblasts and of smooth muscle cells as previously described. This finding suggest a derangement in epithelial-stromal interactions as the underlying pathophysiology in AMH.

Adenomyomatous hyperplasia of the extrahepatic bile duct: a systematic review of a rare lesion mimicking bile duct carcinoma.

Adenomyomatous hyperplasia (AH) is a tumor-like inflammatory hyperplastic lesion. In the biliary system, AH commonly arises in the gallbladder, but AH of the extrahepatic bile duct is extremely rare. AH usually develops and is found with symptoms related to biliary stenosis or obstruction, but there are few disease-specific manifestations. It is difficult to make a definitive diagnosis by imaging or cytopathological examination; thus, surgical resections were performed in all past reported cases. The pathophysiological etiology of AH is unknown, but it is considered to be associated with chronic inflammation. According to the epidemiological findings of cases reported to date, the possibility of malignant transformation is considered to be negative. However, the symptoms and imaging findings of AH are difficult to distinguish from those of early-stage bile duct carcinoma. In the current review, we discuss the epidemiology, pathophysiology, diagnosis, and management of AH of the bile duct.

HNF1B, EZH2 and ECI2 in prostate carcinoma. Molecular, immunohistochemical and clinico-pathological study

Hepatocyte nuclear factor 1 beta (HNF1B) is a tissue specific transcription factor, which seems to play an important role in the carcinogenesis of several tumors. In our study we focused on analyzing HNF1B in prostate carcinoma (PC) and adenomyomatous hyperplasia (AH), as well as its possible relation to the upstream gene EZH2 and downstream gene ECI2. The results of our study showed that on an immunohistochemical level, the expression of HNF1B was low in PC, did not differ between PC and AH, and did not correlate with any clinical outcomes. In PC, mutations of HNF1B gene were rare, but the methylation of its promotor was a common finding and was positively correlated with Gleason score and stage. The relationship between HNF1B and EZH2/ECI2 was equivocal, but EZH2 and ECI2 were positively correlated on both mRNA and protein level. The expression of EZH2 was associated with poor prognosis. ECI2 did not correlate with any clinical outcomes. Our results support the oncosuppressive role of HNF1B in PC, which may be silenced by promotor methylation and other mechanisms, but not by gene mutation. The high expression of EZH2 (especially) and ECI2 in PC seems to be a potential therapeutic target.

Association of Connexin 32 with Prostate Volume and PSA Level in Prostatic Adenocarcinoma and Adenomyomatous Hyperplasia

Association of Connexin 32 with Prostate Volume and PSA Level in Prostatic Adenocarcinoma and Adenomyomatous Hyperplasia

Preneoplastic and neoplastic gallbladder lesions detected after cholecystectomy.

IntroductionGallbladder cancer (GBC) is diagnosed often incidentally after cholecystectomies, with a rate of 0.1–3%.AimTo review the clinical and morphological aspects of GBC and pre-neoplastic lesions in patients who underwent cholecystectomy.Material and methodsA total of 5026 patients who underwent cholecystectomy between January 1, 2012 and December 31, 2017 were included in the study. Histological changes (acute cholecystitis, adenomyomatosis, xanthogranulomatous cholecystitis (XGC), polyps, antral metaplasia, intestinal metaplasia (IM), dysplasia, cancer, and others) in gallbladders (GB) from 5029 patients who underwent cholecystectomy for cholelithiasis were analysed.ResultsGallbladder cancer was more common in women than in men (14/4 = 3.5). A significant relation was found between cholelithiasis and GBC (p = 0.031). Of the patients with GBC, six had stage 1a (T1a + T1b), five had stage 1b (T2N0), two had stage 2 (T3N0), three had stage 2b (T1-3 N1), one had stage 3 (T4 N0), and one had stage 4 (T3N1M1). The IM was more common in females than in males (K/E = 3.3). A significant relationship was found between cholecystitis and IM (p < 0.001). A significant association was observed between IM and adenomyomatosis hyperplasia (p = 0.016).ConclusionsIn this study, it was observed that adenomyomatous hyperplasia and adenomatous polyp were associated with metaplastic changes in the GB pathologies, including XGC and follicular cholecystitis. It is thought that metaplasia-dysplasia may be associated with GBC. However, further studies on GB carcinogenesis are needed.

Intracystic Papillary Neoplasm of the Gallbladder Arising from a Localized Adenomyomatous Hyperplasia

만성담낭염에 흔히 동반되는 담낭의 ì„ ê·¼ì¢ ì¦ì€ ìœ¡ì•ˆì  형태에 따라 ë¶„ì ˆí˜•, 국소형, 미만형의 세가지로 ë¶„ë¥˜í• ìˆ˜ 있다. ì„ ê·¼ì¢ ì¦ì—ì„œ 드물게 담낭암의 ì „êµ¬ì„±ë³‘ë³€ì´ë‚˜ 담낭암이 발생하기도 하는데, 대부분 ë¶„ì ˆí˜• ì„ ê·¼ì¢ ì¦ì—ì„œ 기원하는 것으로 ì•Œë ¤ì ¸ 있다. 담낭암의 ì „êµ¬ì„±ë³‘ë³€ 중 하나인 담낭내 ìœ ë‘ëª¨ì–‘ì¢ ì–‘ì€ 담낭의 ì ë§‰ 상피에서 기원하여 내강 내로 자라면서 ìš©ì¢ ì´ë‚˜ ìœ ë‘ì¢ ì„ 형성하는 것이 ì¼ë°˜ì ì´ë‹¤. 이번 증례에서 담낭 ì ë§‰ì˜ ìš©ì¢ ì´ë‚˜ ìœ ë‘ì¢ ì„ 형성하지 ì•Šê³ ê·¼ìœ¡ì¸µì— 국한되어 있으면서 국소형 ì„ ê·¼ì¢ ì¦ì—ì„œ ìœ ëž˜í•œ ë‹´ë‚­ë‚´ìœ ë‘ëª¨ì–‘ì¢ ì–‘ 1예를 ë³´ê³ í•˜ê³ ìž 한다. Keywords: ì„ ê·¼ì¢ ì„± 증식증, ì„ ê·¼ì¢ ì¦, ìœ ë‘ëª¨ì–‘ì¢ ì–‘, 담낭

A case report of intracholecystic papillary neoplasm of the gallbladder resembling a submucosal tumor

BackgroundIntracholecystic papillary neoplasm (ICPN) is defined as papillary tumors detected macroscopically in the gallbladder. We report a case of ICPN which exhibited the atypical form like a submucosal tumor.Case presentationA 70-year-old man was admitted to our hospital because of hepatic disorder. Computed tomography and magnetic resonance imaging showed irregular thickening of the wall within the gallbladder fundus. Because the lesion might have been malignant, we performed laparoscopic cholecystectomy and liver bed resection. Macroscopic findings showed the mucosal surface of the tumor was smooth, and its form was similar to that of a submucosal tumor. Histopathological examination revealed papillary tumors within the mass with low-grade dysplasia; therefore, we diagnosed ICPN.ConclusionIn the present case, ICPN was resembling a submucosal tumor macroscopically because the tumors arose into the Rokitansky-Aschoff sinus and the adenomyomatous hyperplasia was merged with the ICPN. It is necessary to consider the possibility of tumor lesions within adenomyomatous hyperplasia.

Adenomatous hyperplasia of the ampulla of Vater

Background: Adenomyomatous hyperplasia of Vaterian system is rare with less than 20 cases reported in the English language literature. Preoperative endoscopic and radiological evaluations findings are of a mass lesion and the typical concern is for malignancy. Diagnosis requires histological examination.

Adenomyomatous hyperplasia of the lower bile duct mimicking a papillary bile duct tumor.

Adenomyomatous hyperplasia of the lower bile duct mimicking a papillary bile duct tumor.

A Resected Case of Adenomyomatous Hyperplasia of Cystic Duct

A Resected Case of Adenomyomatous Hyperplasia of Cystic Duct

Adenomyomatous Hyperplasia of the Ampulla of Vater Masquerading as Malignancy: A Case Series

Introduction: Adenomyomas are benign lesions rarely seen in the ampulla of Vater, composed of heterotopic pancreatic tissue. Patients may present with biliary obstructive, abnormal liver tests, and/or imaging abnormalities, but may be found incidentally. Endoscopic sampling of the papilla may show epithelial cell atypia suggesting dysplasia. Patients often undergo invasive surgical resection for presumed malignancy. In this case series 2 patients underwent pancreaticoduodenectomy for distal common bile duct (CBD) brush cytology adequate for adenocarcinoma with ultimate surgical pathology diagnosis revealing benign adenomyomatous hyperplasia (AH). Case 1: A 74-year-old female with a history of cholecystectomy presents with recent colonic surgery complicated by an intra-abdominal abscess. Computed tomography (CT) imaging showed new significant dilatation of the CBD without pancreatic mass. The patient underwent endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) to further investigate dilatation. Gross dilatation of the CBD to 18 mm down to the ampulla and pancreatic duct prominence of 3.5 mm was confirmed with EUS. Cholangiogram showed significant upstream CBD dilation and a 1-cm stricture of the distal CBD. She underwent sphincterotomy, cytology brushings of the distal CBD, and biliary stenting. Cytology was positive for malignant adenocarcinoma. A pancreaticoduodenectomy was performed. Surgical pathology showed AH of the ampulla of Vater and incidental focal low-grade pancreatic intraepithelial neoplasia. Her postoperative course has been uneventful and she is doing well. Case 2: A 73-year-old female with a history of cervical carcinoma, chronic kidney disease, and cholecystectomy presents with epigastric pain, back pain, dark urine, and weight loss. MRCP showed CBD dilatation to 20 mm. EUS revealed prominent pancreatic duct (3 mm) and CBD dilatation to 20 mm (10 mm in the distal CBD). Cholangiogram showed a shelf with abrupt tapering in the distal CBD. She underwent sphincterotomy, cytology brushings of the distal CBD, and biliary stenting. Cytology showed distal CBD high-grade biliary intraepithelial neoplasia; could not exclude adenocarcinoma. After pancreaticoduodenectomy, surgical pathology specimens of the ampulla of Vater showed features of AH without carcinoma. Her course has been uneventful after postoperative recovery. Discussion: Although uncommon, AH should be considered in the differential of CBD dilatation. Brush cytology may be highly suggestive of dysplasia and lead to surgical resection. Gastroenterologists should be aware of AH of the ampulla of Vater as a rare benign clinical entity which may mimic a pancreaticobiliary malignancy. Disclosure - Dr. Shah - Speaker’s Bureau: US Endoscopy.

Seek and ye shall find: the importance of careful macroscopic examination and thorough sampling in 2522 cholecystectomy specimens.

Gallbladder dysplasia and carcinoma (GBDC) vary greatly in incidence worldwide. We aimed to determine their prevalence in an Irish population, to assess the influence of tissue sampling protocols upon GBDC diagnosis, and to correlate various macroscopic and microscopic features with GBDC. We retrospectively reviewed histology reports of cholecystectomy specimens accessioned from 2000 to 2013. A total of 2522 cholecystectomy reports were reviewed, from 1860 female and 662 male patients. Male patients were significantly older (54.8 vs 46.8 years). There were 29 cases of dysplasia (1.15%) and 12 cases of carcinoma (0.48%), of which 10 were primary gallbladder cancers (0.4%). In 83.4% of cases, there was pathologic or radiologic evidence of cholelithiasis. Histologic findings included chronic (91.1%) or acute (15.4%) cholecystitis, cholesterosis (10.9%), adenomyomatous hyperplasia (2.1%), xanthogranulomatous inflammation (2.02%), and "porcelain" gallbladder (0.2%). Patients with GBDC were more likely to have a macroscopically identifiable lesion (29.4% vs 1.8%, positive predictive value, 18.18%, negative predictive value, 99.03%). Gallbladder dysplasia and carcinoma patients also had larger gallstones (median, 19 vs 12 mm) and were more likely to have adenomyomatous hyperplasia (8.8% vs 2.05%). When cases with a macroscopically identifiable lesion or clinical details suggestive of a gallbladder tumour were excluded (n = 2385), GBDC was significantly more frequently diagnosed if multiple tissue blocks had been sampled (2.91% vs 0.76%; relative risk (RR), 3.836). Rates of GBDC in Irish cholecystectomy specimens are low. The absence of a macroscopically identifiable lesion has a high (but not 100%) negative predictive value for GBDC. Sampling with more than 1 block significantly increases pickup rates of GBDC in these cases.

Endoscopic Ultrasound Examination of the Papilla and the Biliary System

Examination of the papilla of Vater and biliary system is feasible using radial or longitudinal scanning echoendoscopes, respectively. The complete extrahepatic bile duct may be followed from the papilla to liver hilum. Additionally, the gallbladder and intrahepatic biliary tree of the left liver can be visualized. Altered anatomy and juxtapapillary duodenal diverticulum may impede the evaluation of the papilla and distal common bile duct. Benign stenosis or adenomyomatous hyperplasia of the papilla are conditions occurring predominantly in older patients with a history of gallbladder stones. EUS is the procedure of choice in the evaluation of a dilated common bile duct or in suspected biliary pathology when transabdominal ultrasound fails. This article is part of an expert video encyclopedia.

総胆管良性腫瘍(adenomyomatous hyperplasia)の1例

総胆管良性腫瘍(adenomyomatous hyperplasia)の1例