Gastric Adenomyosis: A Rare Cause of Pyloric Mass in Children

Abstract

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.

Keywords: Adenomyoma; gastric outlet obstruction; myoepithelial hamartoma.

Figure 1

Contrast-enhanced computed tomography scan of the abdomen showing the presence of a heterogeneously enhancing mass (white solid arrow) in the anteroinferior wall of the gastric antrum causing luminal obstruction. (a) The mass also showed focal fluorodeoxyglucose uptake (white arrow in b) on positron emission tomography scan

Figure 2

(a) Thickened pylorus; (b) Expansion of submucosa and muscularis by smooth muscle cells (black arrow) in a collagenous stroma (white arrow) (H and E, ×40); (c) Dilated ductal structures and Brunner type glands are seen surrounded by the smooth muscle cells (arrow) (H and E, ×10); (d) periodic acid–Schiff stain (×100) highlights the mucus within the glands (arrow); (e) CK7 immunohistochemistry (×200) highlights the dilated ductal structures lined by intestinal epithelium; (f) synaptophysin staining (×200) does not demonstrate pancreatic tissue