Gastric adenomyoma causing outlet obstruction

Byline: M. Suma, P. Jayalakshmy, R. Resna, Joy. Augustine

Adenomyoma of stomach is a rare condition that may or may not present with symptoms, often depending on the location of the tumor. Here, we present a case of gastric adenomyoma with pancreatic heterotopia in the pyloric region causing outlet obstruction. Clinically, radiologically, and histologically adenomyoma of the stomach may mimic gastric malignancy. Awareness of this lesion is necessary to avoid misdiagnosis of the condition.

Introduction

Adenomyoma or myoepithelial hamartoma is a lesion with mainly two components-glandular or ductal structures and smooth muscle proliferation. It is considered to be a hamartoma. The most common locations of this type of tumor in the gastrointestinal tract are stomach (25–38%), duodenum (17–36%), and jejunum (15–21%).[sup][1]

In the stomach, the most common location is the antrum (85%). In the pyloric region, the incidence is 15%.[sup][2] Thickening of the wall leads to narrowing of the lumen and results in gastric outlet obstruction. The patient then may need surgical intervention.

Case Report

A 55-year-old female patient presented with abdominal pain and vomiting of 5 months duration. Ultrasound examination of the abdomen showed superficial thickening of the pyloric region. On gastroscopic examination, the patient was found to have gastric outlet obstruction. At this time, a clinical diagnosis of carcinoma of the stomach was made. The patient underwent distal gastrectomy with gastrojejunostomy. We received the distal gastrectomy specimen with attached omentum [Figure 1].{Figure 1}

The stomach measured 12.5 cm along the greater curvature and 3 cm along the lesser curvature. Omentum measured 8.5 cm x 4 cm x 1 cm. Cutting through the greater curvature, showed a diffuse, circumferential thickening of the wall at the pyloric region m/s 3.5 cm x 0.5 cm x 1 cm...