Gallbladder adenomyomatosis: Diagnosis and management

Gallbladder (GB) adenomyomatosis (ADM) is a benign, acquired anomaly, characterized by hypertrophy of the mucosal epithelium that invaginates into the interstices of a thickened muscularis forming so-called Rokitansky-Aschoff sinuses. There are three forms of ADM: segmental, fundal and more rarely,...

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Bibliographic Details
Published in:Journal of visceral surgery 2017-10, Vol.154 (5), p.345-353
Main Authors: Golse, N, Lewin, M, Rode, A, Sebagh, M, Mabrut, J-Y
Format: Article
Language:English
Subjects:
Adenomyoma - diagnostic imaging
Adenomyoma - pathology
Adenomyoma - surgery
Aged
Biopsy, Needle
Cholangiography - methods
Cholecystectomy - methods
Diagnosis, Differential
Female
Gallbladder Diseases - diagnostic imaging
Gallbladder Diseases - pathology
Gallbladder Diseases - surgery
Gallbladder Neoplasms - diagnostic imaging
Gallbladder Neoplasms - pathology
Gallbladder Neoplasms - surgery
Humans
Immunohistochemistry
Magnetic Resonance Imaging - methods
Male
Middle Aged
Prognosis
Risk Assessment
Treatment Outcome
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Summary:Gallbladder (GB) adenomyomatosis (ADM) is a benign, acquired anomaly, characterized by hypertrophy of the mucosal epithelium that invaginates into the interstices of a thickened muscularis forming so-called Rokitansky-Aschoff sinuses. There are three forms of ADM: segmental, fundal and more rarely, diffuse. Etiology and pathogenesis are not well understood but chronic inflammation of the GB is a necessary precursor. Prevalence of ADM in cholecystectomy specimens is estimated between 1% and 9% with a balanced sex ratio; the incidence increases after the age of 50. ADM, although usually asymptomatic, can manifest as abdominal pain or hepatic colic, even in the absence of associated gallstones (50% to 90% of cases). ADM can also be revealed by an attack of acalculous cholecystitis. Pre-operative diagnosis is based mainly on ultrasound (US), which identifies intra-parietal pseudo-cystic images and "comet tail" artifacts. MRI with MRI cholangiography sequences is the reference examination with characteristic "pearl necklace" images. Symptomatic ADM is an indication for cholecystectomy, which results in complete disappearance of symptoms. Asymptomatic ADM is not an indication for surgery, but the radiological diagnosis must be beyond any doubt. If there is any diagnostic doubt about the possibility of GB cancer, a cholecystectomy is justified. The discovery of ADM in a cholecystectomy specimen does not require special surveillance.
ISSN:1878-7886
1878-7886
DOI:10.1016/j.jviscsurg.2017.06.004