Ampulla of Vater - Adenomyoma

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Ampulla of Vater

Benign/non-neoplastic

Adenomyoma

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 26 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Also called adenomyomatous hyperplasia
● Rare, benign
● Usually stomach, duodenum, jejunum
● Often causes pain in right upper quadrant, radiating to back
● May cause biliary obstruction and common bile duct dilation (Arch Pathol Lab Med 1987;111:388)

Case reports
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● 55 year old woman with history of duodenal ulcers (Arch Pathol Lab Med 2001;125:701)
● 74 year old woman presenting as acute recurrent pancreatitis (World J Gastroenterol 2007;13:2892)

Treatment
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● Excision

Gross description
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● Mass at head of pancreas, usually 0.5 cm or more

Gross images
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Top: pedunculated polypoid tumor (2 cm) in lower bile duc, common bile duct showed marked dilatation; Bottom: tumor localized in bile duct, but no infiltration into surrounding tissue

Top: common bile duct shows marked dilatation, but no apparent tumor; Bottom: small ill-defined nodular lesion of adenomyomatous hyperplasia

Micro description
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● Well circumscribed, nodular proliferation of smooth muscle cells, ducts and glands, clearly disorganized compared to normal
● Ducts and glands are lined by columnar/cuboidal cells
● No atypia, no mitoses, usually no pancreatic tissue

Micro images
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Benign ducts with whorled smooth muscle stroma

a-proliferation of epithelial glandular cells and stromal myofibroblastic spindle cells without atypia; b-surface epithelial cells are MUC5AC+; c-most inner epithelial cells are MUC6+; d-few inner pithelial cells are focally CA/HIK1083+

a-proliferation of epithelial glandular cells and stromal myofibroblastic spindle cells without atypia; b-inner epithelial cells in the inner area rarely expressed MUC5AC; c-most inner epithelial cells in the inner area expressed MUC6; d-a few inner epithelial cells expressed CA/HIK1083

Positive stains
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● MUC6, focal surface positivity for MUC5AC (J Hepatobiliary Pancreat Sci 2010;17:275)

Negative stains
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● MUC1, MUC4

Differential diagnosis
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● Normal intraampullary common bile duct (normally has dense muscular layer)
● Ectopic pancreatic tissue
● Fibroadenoma
● Brunner gland hyperplasia

End of Ampulla of Vater > Benign/non-neoplastic > Adenomyoma

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