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• W1656827655 abstract "Adenomyomatosis of the gallbladder is an acquired hyperplastic condition of unknown etiology that results in excessive proliferation of the surface epithelium. This proliferative epithelium projects into the gallbladder lumen and also invaginates into a thickened muscle layer creating Rokitansky-Aschoff sinuses. The disorder typically involves the fundus of the gallbladder (focal type) but, on occasions, may involve other segments of the gallbladder wall (segmental type) or the whole of the gallbladder (diffuse type). One effect of segmental disease is the creation of an “hour-glass” appearance. Adenomyomatosis can be found in between 1% and 5% of cholecystectomy specimens. The disorder is more common in women than men and up to 60% of patients have coexisting gallbladder calculi. The diagnosis is usually made by radiological studies in symptomatic patients but, in some, the disorder is an asymptomatic “incidental finding”. In occasional patients, the radiological appearance can mimic an early gallbladder cancer, particularly if the disorder is of a segmental type. The cause of adenomyomatosis remains unclear but reports of an association with anomalous pancreaticobiliary ductal union raise the possibility of a link with pancreatic secretions. A 44-year-old man was investigated because of episodes of right upper quadrant pain over the preceding 2 weeks. Various blood tests were within the reference range. An upper abdominal ultrasound study showed thickening of the wall of the fundus of the gallbladder as well as an irregular gallbladder wall with “comet-tail” artefacts (Figure 1 left). These artefacts are created by the presence of echogenic material (usually debris or cholesterol crystals) within the Rokitansky-Aschoff sinuses. The computed tomography scan showed focal thickening with beady enhancement in the fundus of the gallbladder (Figure 1 right). Laparoscopic cholecystectomy was performed and examination of the resected specimen showed a granular mucosal surface with focal thickening in the fundus. Histological evaluation (hematoxylin and eosin x20) showed prominent epithelial proliferation around Rokitansky-Aschoff sinuses (Figure 2, short arrow), dilated epithelial invaginations into the muscle layer and adventitia (long arrow) and hyperplastic smooth muscle bundles (Figure 2, thick arrow). The appearance was typical of adenomyomatosis. Although the name includes the prefix adeno-, the disorder is not thought to predispose to carcinoma of the gallbladder. Cholecystectomy is indicated for symptomatic patients and those with radiological features suspicious for early cancer." @default.
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• W1656827655 date "2013-09-23" @default.
• W1656827655 modified "2023-10-11" @default.
• W1656827655 title "Hepatobiliary and Pancreatic: Adenomyomatosis of the gallbladder" @default.
• W1656827655 doi "https://doi.org/10.1111/jgh.12382" @default.
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