Korean J Gastroenterol.  2013 Dec;62(6):352-358. 10.4166/kjg.2013.62.6.352.

Clinical, Pathological, and Immunohistochemical Features of Adenomyoma in the Ampulla of Vater

• Choi YH
• Kim MJ
• Han JH
• Yoon SM
• Chae HB
• Youn SJ
• Kang MH
• Sung R
• Choi JW
• Park SM

• KMID: 1711291
• DOI: http://doi.org/10.4166/kjg.2013.62.6.352

Abstract

BACKGROUND/AIMS
Ampullary adenomyoma is a benign lesion whose malignant potential has yet to be confirmed. Despite its benign nature, adenomyoma is frequently misdiagnosed as a carcinoma or adenoma and is overtreated by extensive surgery. This study was performed to analyze the clinical, pathological, and immunohistochemical features of adenomyomas in the ampulla of Vater.
METHODS
Nine cases of adenomyoma in the ampulla of Vater, diagnosed in Chungbuk National University Hospital between 2008 and 2011, were enrolled in this study. We reviewed the clinical data on the symptoms, laboratory data, and radiologic findings of the abdominal computed tomography and endoscopic retrograde cholangiopancreatography. For pathological analysis, all the slides were reviewed by one pathologist, and immunohistochemical stainings with antibodies against cytokeratin 7 (CK7), cytokeratin 20 (CK20), alpha-smooth muscle actin (alpha-SMA), and Ki-67 antigen were performed.
RESULTS
All the cases were CK7 positive and CK20 negative. A strong cytoplasmic expression of alpha-SMA was confirmed in all cases. The Ki-67 index was less than 1% in eight cases and 5% in one case. Four cases underwent endoscopic papillectomy, and one case received surgical ampullectomy during colorectal cancer surgery. Five cases that underwent endoscopic or surgical treatment remained symptom-free for three years. Four cases that were closely observed with repeated endoscopic examinations exhibited no interval changes in the papillary lesions.
CONCLUSIONS
Endoscopic biopsy and immunohistochemistry can aid in the diagnosis of ampullary adenomyomas. Endoscopic papillectomy or surgical ampullectomy is adequate for the treatment of symptomatic ampullary adenomyomas.

Keyword

Adenomyoma; Ampulla of Vater; Immunohistochemistry

MeSH Terms

Actins/metabolism
Adenomyoma/*pathology/surgery
Aged
Ampulla of Vater/*pathology
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct Neoplasms/*pathology/surgery
Female
Humans
Immunohistochemistry
Keratin-20/metabolism
Keratin-7/metabolism
Ki-67 Antigen/metabolism
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
Actins
Keratin-20
Keratin-7
Ki-67 Antigen

Figure

• 

  Fig. 1. Radiologic findings of adenomyomas in the ampulla of Vater. Abdominal CT (A, axial view; B, coronal view) showed a 1.4-cm mass protruding into the duodenal lumen with a dilated common bile duct (arrows). (C) Endoscopic retrograde cholangiopancreatography showed a dilated biliary tract (arrow).

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  Fig. 2. Endoscopic view of ampullary adenomyomas. Enlarged major papilla and villous and granular mucosa around the papillary orifice could be identified in all cases; each case matched from A to I.

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  Fig. 3. Pathological and immunohistochemical features of adenomyomas in the ampulla of Vater. (A) Hyperplastic glandular lobules covered by a single layer of epithelium were surrounded by hyperplastic mesenchymal tissues composed of muscle fibers, fibroblasts, myofibroblasts, and capillaries (H&E, ×200). (B) Immunohistochemical staining with the Ki67 antibody level detected at less than 1% (×40). (C, D) α-SMA expression (arrows) in the myofibroblastic component (×40 and ×400, respectively). (E, F) Strong CK7 expression (arrows) in the epithelial lining of the glandular structures (×40 and ×400, respectively). (G, H) No CK20 expression (arrows) in the epithelial lining of the glandular structures (×40 and ×400, respectively).

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  Fig. 4. Endoscopic papillectomy for an ampullary adenomyoma. (A) Endoscopic papillectomy was performed after pancreatic stent insertion. (B) Endoscopic view of the stent placed in the biliary duct after papillectomy. (C) Endoscopic papillectomy was performed without prior pancreatic stent insertion. (D) Endoscopic view of the major papilla after papillectomy.

Reference

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