title: Clinical, pathological, and immunohistochemical features of adenomyoma in the ampulla of vater.
abstract: OBJECTIVE
  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), α-smooth muscle actin (α-SMA), and Ki-67 antigen were performed.
  
  
  RESULTS
  All the cases were CK7 positive and CK20 negative. A strong cytoplasmic expression of α-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.
authors.affiliation: Department of Internal Medicine, Chungbuk National University College of Medicine, 52 Naesudong-ro, Heungdeok-gu, Cheongju 361-711, Korea.
authors.forename: Yong Hyeok
authors.initials: YH
authors.lastname: Choi
authors.forename: Mi Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Joung Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Soon Man
authors.initials: SM
authors.lastname: Yoon
authors.forename: Hee Bok
authors.initials: HB
authors.lastname: Chae
authors.forename: Sei Jin
authors.initials: SJ
authors.lastname: Youn
authors.forename: Min Ho
authors.initials: MH
authors.lastname: Kang
authors.forename: Rohyun
authors.initials: R
authors.lastname: Sung
authors.forename: Jae Woon
authors.initials: JW
authors.lastname: Choi
authors.forename: Seon Mee
authors.initials: SM
authors.lastname: Park
mesh_terms: D000199:Actins / Q000378:metabolism; D018194:Adenomyoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053554:Keratin-20 / Q000378:metabolism; D053552:Keratin-7 / Q000378:metabolism; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: C541116:ACTA2 protein, human; D000199:Actins; D053554:Keratin-20; D053552:Keratin-7; D019394:Ki-67 Antigen