Adenomyomatous hyperplasia of the papilla of vater: A sequela of chronic papillitis?

doi:10.1016/S1092-9134(99)80045-8

Annals of Diagnostic Pathology

Volume 3, Issue 3, June 1999, Pages 174-177

https://doi.org/10.1016/S1092-9134(99)80045-8 Get rights and content

A case of adenomyomatous hyperplasia of the papilla of Vater is described. The lesion presented as a small polypoid tumor projecting into the duodenal lumen, causing obstruction and dilatation of the common bile duct. Serial cross-section of the ampulla showed diffuse thickening of the muscular layer corresponding to Oddi's sphincter, with resulting narrowing of the lumen. Many ductal or glandular components were dispersed within the mucosa and the muscular layer and were admixed with lymphocytes, a few lymphoid aggregates, and fibrosis. Based both on the absence of cellular atypia and the presence of inflammation, fibrosis, and preservation of the normal architecture of the ampulla, we favor the interpretation that this hyperplastic lesion represents a sequela of chronic papillitis. The different diagnoses for this lesion are presented along with a review of the literature.

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Cited by (17)

Adenomyoma of the main biliary tract: A real diagnostic trap. Two cases and a review of the literature
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L’adénomyome de la voie biliaire principale (VBP) est une lésion bénigne simulant cliniquement, radiologiquement et lors de l’intervention une pathologie tumorale pancréaticobiliaire. Ces similitudes conduisent à la réalisation de duodénopancréatectomies céphaliques inutiles. Nous rapportons deux cas d’adénomyome de la VBP ayant conduit à une duodénopancréatectomie céphalique. L’analyse de ces cas et la revue de la littérature montrent que la connaissance de cette pathologie, tant du point de vue de l’imagerie que de l’anatomopathologie, associée à des explorations invasives pré et peropératoires (biopsies sous échoendoscopie, brossage cholédocien et examens extemporanés) permettent parfois de confirmer l’existence d’adénomyome, ce qui permet d’éviter des résections inutiles. La surveillance semble a priori suffisante lorsque le malade est asymptomatique. En revanche, si le malade est symptomatique, la résection segmentaire chirurgicale ou endoscopique est le traitement à mettre en œuvre.
Adenomyoma of the biliary tract is a benign neoplasm but its clinical, radiological and intraoperative features can mimick pancreatic or biliary cancer. These similarities may yeald to useless pancreatoduodenectomy. We report here two cases of adenomyoma treated by pancreatoduodenectomy. The analysis of these two cases and the review of litterature show that radiological and pathological knowledge of this disease, associated with pre and intraoperative evaluation (echoendoscopy-guided biopsy, brushing and intraoperative biopsy) can achieve diagnosis and thus may avoid inappropriate resection. For asymptomatic patient, simple follow-up seems to be the rule. For symptomatic patient endoscopic resection or surgical segmentary resection where appropriate is recommanded.
The clinical significance of papillitis of the major duodenal papilla
2002, Gastrointestinal Endoscopy
Citation Excerpt :
Papillitis may be caused by passage of biliary stones, peripapillary diverticulum, parasites, and infection.17 Chronic recurrent inflammation may induce fibrosis or dysfunction of the sphincter of Oddi.18 This may result in cholestasis, which may in turn cause biliary pain, an obstructive pattern of liver function tests, bile duct dilatation, and even cholangitis.
Background: This study investigated the clinical significance of papillitis of the major duodenal papilla and analyzed the correlation between endoscopic and histologic papillitis in patients with biliary or pancreatic disorders. Methods: Eighty-seven patients and 12 healthy control subjects were enrolled. The endoscopic appearance of papillitis was classified by two blinded endoscopists, and biopsy specimens were taken of the papilla. Various factors were prospectively analyzed to identify any relationship with the endoscopic severity of the papillitis. Results: By univariate analysis, a clinically acute inflammatory condition and elevation of serum transaminase levels were significantly associated with moderate and severe endoscopic papillitis (p < 0.05). However, by multivariate analysis, only a clinically acute inflammatory condition was significantly associated with moderate and severe endoscopic papillitis (p < 0.001). The endoscopic severity of papillitis was poorly correlated with monocyte infiltration, but there was a good correlation with neutrophil infiltration. Moderate and severe papillitis were not observed in healthy volunteers. Conclusions: Moderate and severe endoscopic papillitis were significantly more common in patients with biliary or pancreatic disorders plus a clinically acute inflammatory condition, whereas moderate and severe papillitis were not observed in healthy volunteers. Moderate and severe endoscopic papillitis are characteristic of biliary or pancreatic disorders. (Gastrointest Endosc 2002;55:877-82.)
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2021, GE Portuguese Journal of Gastroenterology
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Case reportAdenomyomatous hyperplasia of the papilla of vater: A sequela of chronic papillitis?

Adenomyoma of the common hepatic duct

J Gastroenterol

Partial biliary obstruction due to adenomyoma of the terminal common bile duct

Clin Nucl Med

Adenomyoma of the common bile duct

Am J Gastroenterol

Primäre Adenomyomatose des Ductus choledochus als seltene Ursache eines Verschluβikterus

Z Gastroenterol

Adenofibromyomatous hyperplasia of the extrahepatic bile duct—A report of two cases

Jpn J Surg

Biliary stricture due to mucosal hyperplasia of the common bile duct: A case report

Hepatogastroenterology

Hamartoma of the hepatic bile ducts

Minn Med

Adenomyoma of the ampulla of Vater: An uncommon cause of bile duct obstruction

Surg Laparosc Endosc

Adenomyoma of the papilla of Vater: A case report

Chin Med J (Taipei)

Adenomyoma of the papilla of Vater

Arch Pathol Lab Med

Case report
Adenomyomatous hyperplasia of the papilla of vater: A sequela of chronic papillitis?