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Myometrial hypertrophy and hyperplasia, which usually on magnetic resonance imaging (MRI) typically reveal an enlarged uterus with ill-defined areas of low signal intensity and a diminished junctional zone, along with small foci of hyperintensity due to ectopic endometrium, are found in uterine adenomyosis. Those are caused by the presence of ectopic endometrial glands and stroma within the uterine myometrium. However, our case reports highlight the importance of recognizing atypical presentations, such as extensive mass-like hyperintense signals resembling a “Fish in a Net” and Swiss cheese pattern on T2-weighted imaging. Recognizing this pattern could aid in preventing misdiagnosis and guiding appropriate management strategies. Furthermore, there is a possibility that the same diagnosis (adenomyosis) could present a different β-human choriogonadotropin hormone (β-HCG) serum level.

Abstract Background Carcinomatous changes from the ectopic endometrial glands in endometriosis have been reported in many studies, but malignant transformation from uterine adenomyosis/adenomyoma is rare. And clear cell-like adenocarcinoma represents a seldom-encountered malignant pathological variant of ectopic endometrium. Case presentation This case report presents a case of a 44-year-old nulliparous woman begun with abdominal pain and intestinal obstruction. Past medical history showed laparoscopic ovarian endometriotic cyst excision. Ultrasound indicated adenomyoma and a parametrial hypoechoic nodule with abundant blood flow signals and unclear boundaries. Deep invasive endometriosis was considered preoperatively. The patient underwent laparoscopic subtotal hysterectomy and bilateral adnexa resection. Chocolate cyst-like lesion was observed in the parametral lesion. Postoperative pathological examinations suggested endometrioid adenocarcinoma arising from eutopic endometrium and adenomyoma. Ectopic endometrium in the myometrium combined with atypical hyperplasia and formation of endometrioid adenocarcinoma. Left parametrial lesions suggested poorly differentiated endometrioid adenocarcinoma combined with clear cell carcinoma. CD10 + endometrial stromal cells were observed surrounding tumor cell masses. Combined with surgical founding and pathological characters of the left parametrial adenocarcinoma, the parametrial lesions were more likely to be carcinomatous changes of the original deep endometriosis.The patient underwent subsequent transabdominal tumor cell reduction surgery and chemotherapy. Conclusion We herein present a rare case of combined endometrioid adenocarcinoma arising from uterine adenomyosis and clear cell carcinoma arising from parametrial deep endometriosis that may help inspire additional studies in the future. The patient underwent robot-assisted laparoscopic subtotal hysterectomy, bilateral adnexa resection, deep endometriosis lesion resection and bilateral ureteral stent placement. Following surgery, a chemotherapy regimen of Taxol and Carboplatin was administered.

We report a case of alpha-fetoprotein-producing endometrioid carcinoma (AFP-EC) that originated within an adenomyoma of the uterine corpus. A 76-year-old Japanese woman was incidentally discovered to have a uterine tumor along with multiple lung nodules. Upon surgical removal of the uterus, it was revealed that the tumor was situated within the adenomyoma. The tumor exhibited microfollicular structures and solid growth patterns, with hyaline globules, clear cell glands, and primitive tumor cells. Immunohistochemical analysis indicated the presence of germ cell markers, including AFP, SALL4, and glypican3, leading to final diagnosis of AFP-EC. Histopathologically, AFP-ECs exhibit characteristics similar to those of AFP-producing neoplasms in other organs. Furthermore, a nomenclature issue arises when distinguishing AFP-ECs from yolk sac tumors of the endometrium in older patients due to their shared features. The concept of retrodifferentiation or neometaplasia suggests that "endometrioid carcinoma with yolk sac tumor differentiation" or "endometrioid carcinoma with a primitive phenotype" may serve as more fitting terms for the diverse spectrum of AFP-producing neoplasms in the endometrium. In conclusion, this case underscores the diagnostic challenges posed by AFP-ECs arising from adenomyomas and emphasizes the need for refining the nomenclature and classification of AFP-producing neoplasms within the endometrium. [ABSTRACT FROM AUTHOR]

Adenomyosis is an intricate pathological condition that negatively impacts the uterus. It is closely related to the more well‐known endometriosis, with which it shares parallels in terms of diagnosis, therapy, and both microscopic and macroscopic features. The purpose of this narrative review is to give a clear univocal definition and outlook on the different, patient‐adapted, surgical treatments. MEDLINE and PubMed searches on these topics were conducted from 1990 to 2022 using a mix of selected keywords. Papers and articles were identified and included in this narrative review after authors' revision and evaluation. From the literature analysis, authors reported the following surgical techniques: laparoscopic double/triple‐flap method, laparotomic wedge resection of the uterine wall, laparotomic transverse H‐incision of the uterine wall, laparotomic wedge‐shaped excision, and laparotomic complete debulking excision by asymmetric dissection technique. Each of these techniques has strengths and weaknesses, but the literature data on the pregnancy rate are somewhat limited. The only certain information is the risk of uterine rupture up to 6.0% after surgical treatment for uterine adenomyosis. Over the years, the surgical approach continued to reach a positive result by minimally invasive treatment, with less hospitalization, less postoperative pain, and less blood loss. Over the years, the gynecological surgeon has gained the skills, training and increasingly sophisticated surgical techniques to target effective therapy. That's why a hysterectomy is no longer the only surgical resource to treat adenomyosis, but in patients who wish to preserve the fertility, there is a wide variety of surgical alternatives. Synopsis: This research summarizes the laparoscopic and laparotomic fertility‐sparing treatments for adenomyosis and adenomyoma, two complex entities, which are difficult to approach surgically due to the subsequent possible sequelae. [ABSTRACT FROM AUTHOR]

Copyright of Türk Radyoloji Seminerleri is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Adenomyosis is benign gynaecological condition characterized by the presence of endometrial tissue (glands and stroma) within the muscular walls of the uterus. While it's relatively common for adenomyosis to occur within the uterus, cases of extra-uterine adenomyosis, outside the uterus, are exceptionally rare. Recently a case was reported of a young woman with a right ovarian ligament. adenomyoma diagnosed histopathologically after surgery for a suspected right adnexal mass. To the best of our knowledge, this is the fourth case reported so far. The present case emphasizes the need for a thorough evaluation of adnexal masses and the feasibility of conservative fertility sparing surgery in a multidisciplinary setting in young patients. This case is notable because it highlights several important aspects of managing such conditions. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Intussusception is a frequent abdominal emergency in infancy, requiring immediate diagnosis and therapeutic intervention. In approximately 90% of cases, intussusception seems to be idiopathic. There has been a reported association of intussusception with lymphoid hyperplasia of Peyer patches in the terminal ileum, possibly acting as the triggering factor. Clinical presentation varies substantially, while the etiology seems idiopathic in most reported cases. Case Report: This case describes a previously healthy 2-month-old girl who presented with an episode of non-bilious vomiting and deterioration during the 12 hours preceding the visit. Abdominal ultrasonography revealed the typical target sign in the right iliac fossa, without visible peristalsis, confirming the diagnosis of intussusception. Failure of non-surgical reduction led to emergency laparotomy with the working diagnosis of intussusception due to Meckel's diverticulum. However, laparotomy instead revealed an adenomyoma of the small intestine, a rare benign tumor-like lesion, as the pathological lead point. Conclusions: This case is interesting for 2 distinct reasons. Not only does it underline the need to maintain a high index of suspicion for triggering factors, even in patients within atypically affected age groups, but it also adds to the remarkably limited selection of reported adenomyomas of the small intestine acting as the pathological lead point for intussusception. In this case report, we aspire to emphasize that especially in patients outside the most affected age group, pediatric surgeons should remain aware of the possibility of adenomyoma as a pathological lead point. [ABSTRACT FROM AUTHOR]

Background: Adenomyoma of the small intestine is rare in children and the clinical characteristics is not clear. The study was to document the clinical characteristics and treatment of children with adenomyoma of the small intestine. Methods: A retrospective study was conducted in children with intestinal adenomyoma from 2010 to 2022. We recorded age, gender, symptoms, location, tumour size and treatment options. Results: Thirteen patients with adenomyoma of the small bowel were included. The median age was 20 months with a male‐to‐female ratio of 10:3 and more than half of the patients were younger than 2 years old. The mean tumour size was 2.0 cm. The lesion was found accidentally in one patient, and the others presented with symptoms of intussusception. A pathological lead point was found on ultrasound in seven patients. All tumours were located in the ileum, ranging from 24 to 260 cm proximal to the ileocecal valve. The tumour was found in an antimesenteric site in eight patients. Three patients suffered intestinal necrosis, and segmental resection of the ileum was performed. Three patients without intestinal necrosis underwent tumour rection, while intestinal resection and anastomosis were performed in the remaining seven. All patients recovered well except one, who developed intussusception 7 days after surgery; that patient underwent surgery and recovered uneventfully. Conclusions: Adenomyoma of the small intestine has a male predominance in children and intussusception is a common presentation. The ultrasound feature is a mass of mixed echogenicity containing several small cystic areas. Surgery is the primary treatment option and the procedure should be chosen based on intraoperative findings. [ABSTRACT FROM AUTHOR]

Radiology plays an essential role in the management of benign gynaecological conditions and includes: ultrasound; computed tomography and magnetic resonance imaging. Each modality has a different role in diagnosis, treatment selection and follow-up. This review discusses the different imaging modalities, their recommended roles in the imaging and imaging findings of common female pelvic pathology. [ABSTRACT FROM AUTHOR]

Objective: Report the clinical case of Gastric Adenomyoma as etiology of pyloric syndrome. Clinical case: We present a 52 years old man who attended the emergency room due pyloric syndrome and who underwent a distal gastrectomy. The pathological report revealed a gastric adenomyoma with ulcerative lesion. Discussion: This pathology is an unusual finding, and the literature describe it with extremely low rate of malignant transformation. Conclusion: Gastric adenomyoma is a infrequent pathology and should be taken into account when endoscopic studies are not enough to determine the etiology of a pyloric syndrome.

Objective: To investigate the safety and efficacy of adjuvant gonadotropin‐releasing hormone agonist (GnRH‐a) treatment followed by maintenance dienogest (DNG) therapy after uterus‐sparing surgery. Methods: Retrospective cohort study. A total of 190 patients with severe adenomyosis underwent uterus‐sparing surgery between January 2010 and June 2020. Of these patients, 90 were analyzed. Forty‐six patients (control group) received adjuvant 6‐month GnRH‐a therapy alone after uterus‐sparing surgery, and 44 patients (maintenance group) received postoperative 6‐month GnRH‐a treatment followed by maintenance DNG therapy (2 mg/day orally). The median follow‐up period was 18 months. The study was analyzed using generalized estimating equations. Results: At baseline, the characteristics of patients in each group were comparable. Compared with the control group, the maintenance group had a significant improvement in the visual analog scale score of dysmenorrhea (P < 0.001), hemoglobin level (P = 0.004), and uterine volume (P = 0.004) from baseline to 18 months after uterus‐sparing surgery. The symptom recurrence rate was significantly lower in the maintenance group than in the control group (4.6% vs. 37.0%, P < 0.001). Conclusions: The findings of this study suggest that combinatorial treatment with GnRH‐a (adjuvant treatment) and DNG (maintenance therapy) represents a safe and effective short‐term therapy after uterus‐sparing surgery for adenomyosis. Synopsis: Maintenance DNG therapy following adjuvant GnRH‐a treatment after uterus‐sparing surgery was identified as an effective therapy for symptom control and prevention of recurrent adenomyosis. [ABSTRACT FROM AUTHOR]

Adenomyoma of small intestine causing intussusception in adults is a rare condition. The small intestine is the second most frequent location, usually in the periampullary area, but the lesion also occurs in the jejunum and ileum.We present a case of 76 years old female who presented with pain abdomen and was diagnosed to have jejunal intussusception. She underwent surgery with segmental resection and anastomosis of jejunum and the histopathological examination revealed jejunal adenomyoma as the pathological lead point. Adenomyoma of jejunum as a lead point should be taken into consideration while dealing with a patient with jejunal intussusception.

To investigate the impact of uterine adenomyosis on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) clinical outcomes and also to evaluate the impact of gonadotropin-releasing hormone agonist (GnRHa) and surgical treatments. Infertile women with adenomyosis undergoing conventional IVF or ICSI were compared with women without adenomyosis. Fertility outcomes were evaluated in two patients with adenomyosis untreated and treated surgically or medically therapy. The review protocol was registered in PROSPERO (CRD42020214586). We consider the live birth rate (LBR) as the primary outcome. The analysis showed that women with adenomyosis had lower LBR (OR 0.59, 95% CI 0.37–0.92, p = 0.02), clinical pregnancy rate (OR 0.66, 95% CI 0.48–0.90), and ongoing pregnancy rate (OR 0.43, 95% CI 0.21–0.88) compared to those without adenomyosis, and miscarriage rate was higher in women with adenomyosis (OR 2.11, 95% CI 1.33–3.33). Surgical treatment increases natural conception in women with adenomyosis although the paucity of data (only two studies), and conversely, treatment with GnRHa does not increase the IVF outcomes. Women with adenomyosis have decreased IVF clinical outcomes. Pretreatment with the use of long-term GnRHa could not be beneficial, even though only three studies were included in the meta-analysis. The major part of the studies has not divided focal and diffuse adenomyosis, and this represents a relevant source of bias: studies conducted with standardized diagnostic criteria for adenomyosis are still needed to determine if the different clinical presentations of such condition could compromise IVF outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Facultad de Medicina Humana is the property of Instituto de Investigaciones en Ciencias Biomedicas de la Universidad Ricardo Palma and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abdominal wall endometriosis (AWE) within the scar of a trocar insertion is seldom reported as a complication of laparoscopy. We describe the case of a 46 year-old woman suffering from uterine leiomyomas who underwent laparoscopic hysterectomy. One year later, she developed a painful abdominal wall mass, beneath the scar of suprapubic port-site trocar insertion. The diagnostic work-up, consisting in ultrasonography, magnetic resonance imaging and needle biopsy led to a diagnosis of AWE. Initially, a progestogen therapy was administered, obtaining relief from pain symptoms but insignificant reduction of lump' size. Therefore, the patient underwent a laparotomic resection of the mass. Pathologic findings showed endometriotic tissue mixed with smooth muscle cells, leading to the diagnosis of extrauterine adenomyoma. Six months after surgery, neither AWE relapse nor incisional hernia was found. To our knowledge, no case of parasitic adenomyoma development in a trocar scar following a laparoscopy has been described before in literature., Competing Interests: All authors declare that there is no conflict of interest., (© Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Gallbladder adenomyoma/adenomyomatous nodule/adenomyomatosis is a benign condition characterized by mucosal invaginations within the gallbladder wall with or without proliferation of smooth muscle fibers. Gallbladder adenomyoma is often asymptomatic and discovered incidentally during imaging studies performed for other unrelated conditions. It can mimic malignancy on radiological findings, creating a diagnostic dilemma. The management and outcome of adenomyoma and malignant lesions of gallbladder are completely different. We present here a rare case of 52-year-old female diagnosed with gallbladder adenomyoma in histopathological examination highlighting the insights into this benign distinctive condition. Therefore, it is essential to completely understand the pathognomonic and histopathological features of gallbladder adenomyoma in order to accurately diagnose this condition., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, B. et al.)

Background: The traditional pathology of adenomyosis (AM) suggests that this is a common benign uterine disease. Hysterectomy is the gold standard of care and is viewed as a decisive treatment for AM; however, more conservative treatment approaches are required to maintain fertility. Unfortunately, there are few studies focusing on medical treatments for AM. The objective was to investigate the effect of gonadotropin-releasing hormone agonist (GnRH-a) combined with dienogest on serum human epididymis secretory protein 4 (HE4) and carbohydrate antigen 125 (CA125) levels in patients with AM and adenomyoma. Methods: We addressed our objective using a prospective cohort design. We selected 120 patients treated for AM and adenomyoma from February 2019 to April 2021 in our hospital. The patients were divided into a control group and a study group. The control group was treated with GnRH-a alone, while the study group was treated with GnRH-a combined with dienogest. The curative effect, dysmenorrhea score, dysmenorrhea grade, serum CA125 and HE4 levels, size of the uterine lesions, and incidence of adverse reactions were compared between the two groups. Results: When comparing the two groups, the study group consisted of 43 cases that were significantly effective, 12 effective cases, and five ineffective cases, thus, the effective rate was 91.67%. The control group displayed 23 significantly effective cases, 21 effective cases, and 16 ineffective cases, thus the effective rate for the control group was 73.33%. The curative effect in the study group was higher than in the control group, and the difference was statistically significant (p < 0.05). There was no significant difference in the dysmenorrhea score between the two groups before treatment (p > 0.05). However, after treatment, the dysmenorrhea score in the study group was lower than in the control group 1 month, 3 months, and 6 months after treatment (p < 0.05). There was no significant difference in the levels of serum CA125 and HE4 between the two groups before treatment, but the levels of serum CA125 and HE4 decreased after treatment, and the levels of serum CA125 and HE4 in the study group were lower than in the control group. There was no significant difference in the size of the uterine lesions between the two groups before treatment (p > 0.05). After treatment, the size of the uterine lesions in the study group was smaller than in the control group (p < 0.05). There was no statistical difference in the incidence of adverse reactions between the study group and the control group. Conclusions: GnRH-a combined with dienogest was effective treatment than the single GnRH-a treatment in patients with AM and adenomyoma as evidenced by decreased serum CA125 and HE4 levels, menstrual volume, and dysmenorrhea. The combined treatment could more effectively alleviate the clinical symptoms, reduce the focus volume, and improve the treatment efficiency. For patients with larger adenomyomas requiring conservative treatment, GnRH-a combined with dienogest is a promising therapeutic option.

ABSTRACT: Mucinous tubular and spindle cell carcinoma of the kidney is a rare subtype of renal cell carcinoma, that is believed to portend a favorable prognosis.Adenomyomas are benign tumors that typically arise from the myometrium. Extrauterine adenomyomas are extremely rare, with only a few cases reported in the literature.Here, we present an unusual case of a 46-year-old woman, with an incidentally detected bulky interpolar left kidney mass measuring 12 cm and multiple lobulated coalescent peritoneal nodules in the large epiploon suspicious for peritoneal carcinomatosis. A biopsy of the lesions revealed a mucinous tubular and spindle cell carcinoma of the kidney and extrauterine adenomyomas of the peritoneum. A left radical nephrectomy was performed and long-term hormone therapy with gonadotropin-releasing hormone agonists was prescribed.The purpose of this article is to focus on these two rare lesions, review the current literature, illustrate their key imaging findings along with pathologic correlation, as well as to discuss the differential diagnosis and clinical management.

Accessory cavitated uterine mass (ACUM) is a rare and unique condition seen in young women. We report cases of ACUMs in two patients, a 14-year-old girl and a 25-year-old woman, both with complaints of severe dysmenorrhea that had started at menarche and had progressively worsened since. A large cystic lesion was localized in the anterolateral wall of the myometrium separate from the endometrium, which was difficult to distinguish from congenital uterine anomalies. Laparoscopic excision of the ACUMs was successful and completely resolved the dysmenorrhea. Early investigation of severe dysmenorrhea in young women can provide appropriate management and relieve symptoms.

Through microscopy, early researchers identified the epithelium on the inner surfaces of the uterus, cervix and Fallopian tubes. The identification of ectopic epithelium was gradual, starting from the gross pathology study of unusual cystic lesions. Towards the end of the nineteenth century, attention focused on the epithelium as a critical component. The term ‘adenomyoma’ was coined around eighteen eighty to designate the majority of mucosa-containing lesions. Several theories were advanced to explain its aetiology. In the main, lesions were considered to arise from invasion from uterine epithelium; implantation of endometrium through retrograde menstruation; hematogenous or lymphatic spread; or from embryonic remnants. Although initially widely rejected, around 1920, an almost unanimous consensus formed on the endometrial nature of epithelial invasions. During the following years, adenomyosis and endometriosis came to be used to distinguished lesions within or outside the uterus. Adenomyosis was attributed to direct infiltration of uterine mucosa into the myometrium, and endometriosis to the implantation of endometrial cells and stroma into the peritoneal cavity through retrograde menstruation. Around the same time, ovarian lesions, initially described as ovarian hematomas or chocolate cysts, were regarded as a form of endometriosis. Three variants of endometriosis were thus described: superficial peritoneal, deep nodular and ovarian endometriomas. Ectopic epithelium has long been recognised as having similarities to tubal, or cervical epithelium. Lesions containing mixed epithelium are often termed Müllerianosis. This article demonstrates the stepwise evolution of knowledge, the role of the pioneers and the difficulties that needed to be overcome. It also demonstrates the value of collaboration and the inter-connected nature of the scientific endeavour.

Purpose To determine the multidetector CT (MDCT) findings that differentiate adenomyoma of the ampulla of Vater (AOV) from localized adenocarcinoma of the AOV. Materials and Methods Sixteen and 30 patients with adenomyoma and localized adenocarcinoma of the AOV, respectively, were evaluated using MDCT. We analyzed the size and attenuation value and presence of uniform enhancement of the lesions, diameters of the extrahepatic bile duct (EHD) and main pancreatic duct, presence of regional lymph node enlargement, and laboratory findings. We determined the independent findings for differentiating adenomyoma from localized adenocarcinoma of the AOV using multivariate analysis. Results The size of the lesion and diameter of the EHD were significantly smaller for adenomyoma than those for localized adenocarcinoma of the AOV (all p < 0.001). In multivariate analyses, a lesion size of ≤ 1.3 cm, an EHD diameter of ≤ 1.3 cm, and an alanine transaminase level of ≤ 31 IU/L significantly differentiated adenomyoma from localized adenocarcinoma of the AOV. When all of these three findings were met, the specificity for adenomyoma of the AOV was 93.3%. Conclusion MDCT imaging may facilitate the differential diagnosis of adenomyoma and localized adenocarcinoma of the AOV based on the size of the lesion and diameter of the EHD.

We report a case of jejunal adenomyoma in a neonate, found during exploratory surgery for bilious vomiting and feeding intolerance. This is the first reported case of neonatal jejunal adenomyoma as an isolated cause of intestinal obstruction.

Sarah Wali,1 Charlotte Porter-Hope,2 Tejal N Amin,1 Tariq Miskry1 1Department of Obstetrics and Gynaecology, St Mary’s Hospital, Paddington, London, W2 1NY, UK; 2Imperial College Medical School, London, UKCorrespondence: Sarah Wali Email Sarah.wali@doctors.org.ukBackground: Although the most common uterine tumour is leiomyoma, the differential diagnoses also include the rarer adenomyoma and leiomyosarcoma. A lack of clear reliable clinical and radiological features makes the triage of uterine masses to the appropriate surgical procedure difficult. In the case of suspicious appearance of a presumed leiomyoma, an open surgical approach is recommended and morcellation is avoided.Case: We present a case of a woman undergoing an elective laparoscopic myomectomy for a fibroid that appeared benign on ultrasound but had suspicious features intraoperatively. The operation was converted to a laparotomy to avoid the risk of morcellation-related seeding in the event that the histology was malignant. The histology was subsequently a benign exophytic adenomyoma.Conclusion: The assessment of the nature of fibroids can be difficult both pre- and intraoperatively, and the need for difficult decision making to convert to open surgery during a laparoscopic myomectomy but with subsequent benign histology should be part of patient counselling.Keywords: adenomyoma, communication, differential diagnosis, converting to laparotomy, morcellation risks, histology

Adenomyomatosis is a rare benign lesion that has been observed in different sites throughout the gastrointestinal tract, most frequently in the gallbladder. Few cases have been described in the stomach, small bowel, bile ducts, and ampullary region. Adenomyomas of the vaterian system (ampulla and common bile duct) have important clinical consequences, since the majority of these lesions present with biliary tract obstruction and mimic malignant behavior. As a consequence, considering the diagnostic difficulty of these lesions, patients are often treated with extensive surgery (pancreaticoduodenectomy). We report 2 cases of adenomyomatosis: one of the ampulla of Vater and the other of the common bile duct, as well as a review of reported cases in the literature. Both of our patients presented with epigastralgia and had laboratory or endoscopic evidence of biliary obstruction. Both patients underwent endoscopic ultrasound, one of them with fine-needle aspiration; however, it was not possible to exclude the possibility of cancer. The diagnosis of adenomyoma was only confirmed by the surgical specimen after pancreaticoduodenectomy.

Objective: Adenomyoma, a reactive and hamartomatous lesion of the gallbladder, is included in the differential diagnosis of several benign and malignant lesions. Macroscopic sampling is very important in the determination of these lesions. The agreed macroscopy protocol in recent years has been prepared by the Hepatopancreatobiliary Pathology Working Group. We aimed to evaluate the clinicopathologic properties of adenomyoma cases in the gallbladder and the contribution of new macroscopy techniques to the diagnosis of adenomyoma in the pre-protocol and post-protocol parts of a one-year period. Material and Method: Two institutes were included in the study. Adenomyoma cases diagnosed in the pre-protocol and post-protocol periods of one year duration were included in the study. Slides and demographic properties of the cases were reexamined. Results: While adenomyoma was present in 22 of 1879 gallbladder before the protocol, it was observed in 32 of 1781 gallbladders in the post-protocol period. 17 of the cases were male and 37 were female. The mean age of the cases was 51.8. 52% of the lesions were located in the fundus. A gallstone was observed in 37 cases, and cholesterolosis in 14 cases. In the comparison of the two periods, the number of cases was lower in the post-protocol period but a 0.6% increase in the diagnosis of adenomyoma was found. Conclusion: Adenomyoma is one of the lesions of the gallbladder that should be recognized but can be easily overlooked macroscopically. When we conducted the sampling according to the last protocol, the increase in the diagnosis of adenomyoma showed that adequate and accurate sampling was very useful for the detection of adenomyoma in the gallbladder.

Extrauterine adenomyoma of the liver is extremely rare. Only a few cases have been reported, and these reports have focused mainly on histopathology. Herein, we report the specific imaging findings of extrauterine adenomyoma of the liver in a 43-year-old woman with epigastric pain, which was initially diagnosed as a hepatic adenoma. CT and MRI revealed a solid and cystic mass with hemorrhagic foci and weak persistent enhancement, located in the subcapsular region of the right hepatic lobe.

BackgroundPulmonary metastasis of benign uterine leiomyoma and uterine endometriosis has been reported; however, pulmonary benign metastasizing uterine adenomyoma has not been reported. Herein, we report the first case of pulmonary benign metastasizing uterine adenomyoma. It is very important to differentiate from pulmonary primary synovial sarcoma; histopathology and immunohistochemistry are very helpful, molecular pathology can be used if necessary.Case PresentationA female patient was admitted to the hospital because of pulmonary nodules. Lung computed tomography (CT) showed a nodular high density shadow in the upper lobe of the right lung, with a clear boundary and a diameter of approximately 1.2 cm. A contrast CT scan showed obvious enhancement, and no obvious lobulation or burr was found. Video-assisted thoracoscopic resection of the tumor was performed. The upper lobe nodules were completely removed. Postoperative pathological report confirmed the lesion as metastatic benign adenomyoma of the right upper lung.ConclusionThe lung is the most common organ for malignant tumor metastasis, and a few benign tumors can also develop pulmonary metastasis. Pulmonary benign metastasizing adenomyoma is extremely rare, and the prognosis is very good after surgical resection. When pulmonary CT shows a solid high-density shadow, we should consider the possibility of a metastatic benign tumor.

Myometrial hypertrophy and hyperplasia, which usually on magnetic resonance imaging (MRI) typically reveal an enlarged uterus with ill-defined areas of low signal intensity and a diminished junctional zone, along with small foci of hyperintensity due to ectopic endometrium, are found in uterine adenomyosis. Those are caused by the presence of ectopic endometrial glands and stroma within the uterine myometrium. However, our case reports highlight the importance of recognizing atypical presentations, such as extensive mass-like hyperintense signals resembling a "Fish in a Net" and Swiss cheese pattern on T2-weighted imaging. Recognizing this pattern could aid in preventing misdiagnosis and guiding appropriate management strategies. Furthermore, there is a possibility that the same diagnosis (adenomyosis) could present a different β-human choriogonadotropin hormone (β-HCG) serum level., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Gastric adenomyoma, a subtype of pancreatic heterotopia, is a rare mural lesion typically located within the antrum or pylorus consisting of well-formed glands lined by a single layer of bland epithelium embedded within dense smooth muscle bundles. Like most forms of pancreatic heterotopia, gastric adenomyomas are usually incidental findings, but may result in obstructive symptoms, especially if situated within the pyloric channel. Malignant degeneration is exceedingly rare, with existing reports lacking detailed morphologic descriptions. Herein, we discuss the case of a 62-year old female who presented to our institution with two months of early satiety and bloating. Imaging revealed a partially cystic mass within the pyloric wall associated with eccentric gastric wall thickening. Endoscopic fine needle aspiration cytology revealed glands embedded in smooth muscle. Distal gastrectomy ultimately revealed an extremely well-differentiated adenocarcinoma arising in a pre-existing adenomyoma of the pyloric channel. In this report, an extensive review of this rare entity is provided, including detailed morphologic and immunohistochemical findings of our case, differential diagnostic considerations, pitfalls of gastric mural lesions that contain epithelium, and a comprehensive literature review.

Deep infiltrating endometriosis (DIE) is a common finding in patients diagnosed with adenomyosis. Women commonly present with severe, incapacitating dysmenorrhea. We report a case of severe dysmenorrhea and lower abdominal tightness for 4 years, diagnosed with posterior adenomyosis. The patient underwent surgery and DIE involving the rectosigmoid and coexisting uterocervical adenomyosis infiltrating bowel muscularis successfully diagnosed and treated using laparoscopic “shaving” technique. Dysmenorrhea significantly resolved after surgery. Laparoscopic surgical “shaving” technique for external adenomyosis infiltrating Rectosigmoid muscularis is feasible, where uterine preservation is desired.

Intussusception is the most common cause of intestinal obstruction among children up to three years of age. Though usually idiopathic, it may seldom be caused by a pathologic lead point. We present the case of a one-month-old female patient who was diagnosed with intussusception secondary to an ileal adenomyoma. To our knowledge, this case represents the youngest patient to be described in literature with an intussusception caused by a hamartoma.

Adenomyoma of the stomach is a benign tumor with a very low incidence. Clinical presentation and imaging modalities are usually nonspecific and variable. A rare case of gastric adenomyoma in a 12-year-old child is being reported who presented with gastric outlet obstruction. The diagnosis could only be established after an excision biopsy performed after multiple diagnostic modalities failed to clinch the diagnosis. The case is being reported in view of the rarity of this entity in the pediatric age group as a cause of gastric outlet obstruction.

Juvenile cystic Adenomyoma( JCA) is a rare form of adenomyosis, affecting young girls. We are presenting three cases of JCA misdiagnosed preoperatively, as unicornuate uterus with haematometra in non communicating rudimentary horn in two cases and fibroid with cystic degeneration in one case. MRI pelvis is the investigation of choice. Complete excision of the lesion done in all the three cases with recurrence in one case