팽대부 선근종의 임상적, 병리학적, 면역조직화학염색의 특징

• Published in: The Korean journal of gastroenterology Vol. 62; no. 6; pp. 352 - 358
• Main Authors: 최용혁, Yong Hyeok Choi, 김미진, Mi Jin Kim, 한정호, Joung Ho Han, 윤순만, Soon Man Yoon, 채희복, Hee Bok Chae, 윤세진, Sei Jin Youn, 강민호, Min Ho Kang, 성노현, Rohyun Sung, 최재운, Jae Woon Choi, 박선미, Seon Mee Park
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 30.12.2013
• Subjects: Adenomyoma; Ampulla of Vater; Immunohistochemistry
• ISSN: 1598-9992

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), 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. (Korean J Gastroenterol 2013;62:352-358)