Content uploaded by Luca Mastracci
Author content
All content in this area was uploaded by Luca Mastracci on Nov 27, 2015
Content may be subject to copyright.
A preview of the PDF is not available
A Rare Polypoid Lesion of the Jejunum
Figures
Figures - uploaded by Luca Mastracci
Author content
All figure content in this area was uploaded by Luca Mastracci
Content may be subject to copyright.
... This low incidence can be explained by underreporting this lesion when discovered, as they can represent an incidental finding at autopsy. Jejunal lesions are by far the least frequent of all small bowel adenomyoma and comprise less than a third of the cases [2,4,6]. ...
... This low incidence can be explained by underreporting this lesion when discovered, as they can represent an incidental finding at autopsy. Jejunal lesions are by far the least frequent of all small bowel adenomyoma and comprise less than a third of the cases [2,4,6]. ...
Adenomyoma is a benign lesion that is most commonly seen in the gallbladder, however, rare cases have been reported where this pathology was encountered in the vicinity of the gastrointestinal tract. The pathogenesis of this lesion is still a controversy, with the previous reports suggesting it to be either a form of hamartoma or incomplete heterotopic pancreas. Jejunal and ileal adenomyoma have been rarely reported, and as of 2016 less than 30 cases were reported in the English literature. The clinical presentation is variable depending on the location of the lesion. Although there are no specific management guidelines for this pathology, a surgical resection is sufficient. However, aggressive surgical approaches, such as pancreaticoduodenectomy for periampullary adenomyoma, have been undertaken in the previous reports due to the misdiagnosis with carcinoma preoperatively. We report a case of a 58-year-old gentleman who was referred to our Hepato- Pancreato-Biliary facility with common bile duct injury post laparoscopic cholecystectomy for hepatico- jejunostomy. Intra-operatively, an intra-luminal, jejunal mass was found measuring 2x2 cm and was about 95 cm from the DJ junction. The lesion was resected with safety margins, and primary anastomosis was done. The final histopathology of the specimen was consistent with adenomyoma, and all of the surgical margins were free.
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.
We report a case of adenomyoma in the small intestine, which is an extremely rare entity. An 81-year-old woman presented to our hospital with a history of three episodes of vomiting accompanied by abdominal pain. Upper gastrointestinal examination via a long tube found intestinal obstruction caused by a tumor of the small intestine. Laparotomy revealed a hard mass, 160 cm distal to the Treitz ligament. Pathological examinations of the resected tumor confirmed a diagnosis of adenomyoma originating in the small intestine. To our knowledge, this is only the second report of an adenomyoma of small intestine causing intestinal obstruction in an adult.
Adenomyoma of the small intestine is an extremely rare condition characterized by abnormal glandular structures surrounded by smooth muscle. We report a case of adenomyoma of the jejunum. The patient was a 61-year-old female with cancer of the sigmoid colon and multiple liver cysts, who was sent to the operation room for exploratory laparotomy and sigmoidectomy. At surgery, a polypoid lesion was incidentally found in the lower jejunum, which was resected. On histologic examination, the morphologic features were typical of adenomyoma. However, new histopathological and immunohistochemistry features are described here, providing evidence that adenomyoma of the jejunum is a form of intestinal epithelial hamartoma.