Adenomyoma of the ileum leading to intussusception

Abstract

Adenomyoma of the ileum is a rare condition. A 68-year-old Japanese man presented with nausea and distension of the abdomen. Enhanced computed tomography of his abdomen revealed wall thickening in the ileum and dilation of the proximal small intestine. Open laparotomy was performed to find the cause of the patient's small bowel obstruction, and a tumor was found in the ileum, which had resulted in intussusception. The tumor and 20 cm of the adjacent ileum were resected. The resected specimen displayed a macroscopic appearance suggestive of a submucosal tumor. Histopathological evaluation showed duct cell proliferation and bundles of smooth muscle cells from the mucosa to the serosa, leading to a diagnosis of adenomyoma. Immunohistochemical examination found that cytokeratin 7 and carbohydrate antigen 19-9 were expressed in the duct epithelia. We report a rare case of ileal adenomyoma leading to intussusception in an adult and present the immunohistochemical evaluation of the adenomyoma.

Keywords: Adenomyoma; Heterotopic pancreatic tissue; Intussusception.

Fig. 1

Enhanced CT of the abdomen and pelvis showed a thickened wall and a tumor-like lesion in the ileum (arrowhead) as well as dilation of the proximal small intestine.

Fig. 2

Loupe image showing proliferating duct cells surrounded by bundles of smooth muscle cells from the submucosa to the serosa (hematoxylin-eosin stain, ×4).

Fig. 3

Immunohistochemical examination revealed strong expression of CK 7 in the proliferating epithelial duct cells (CK 7 stain, ×40).