Introduction
Background
Differentiating between adenomyomatosis and cholesterolosis is difficult at times. Hyperplastic cholecystosis is the term used to describe cholesterolosis and adenomyomatosis.1,2,3
Longitudinal sonogram of gallbladder shows a hyperechoic focus in the anterior wall with reverberation artifact, which is characteristic of hyperplastic cholecystosis.
Recent study
Ching et al studied the accuracy of CT in differentiating adenomyomatosis from gallbladder cancer in a retrospective study of 36 patients with pathologically proven adenomyomatosis or gallbladder cancer who had undergone preoperative abdominal CT. The authors determined from study findings that CT is limited in the detection and differentiation of adenomyomatosis and gallbladder cancer, but the diagnosis of adenomyomatosis can be made with reasonable accuracy when thickening of the gallbladder wall is seen to contain small cystic-appearing spaces.2
For excellent patient education resources, visit eMedicine's Liver, Gallbladder, and Pancreas Center and Cholesterol Center. Also, see eMedicine's patient education articles Gallstones, High Cholesterol, and Cholesterol FAQs.
Pathophysiology
Adenomyomatosis is a benign condition characterized by hyperplastic changes of unknown etiology involving the gallbladder wall and causing overgrowth of the mucosa, thickening of the muscular wall, and formation of intramural diverticula or sinus tracts termed Rokitansky-Aschoff sinuses. Adenomyomatosis is a common tumorlike lesion of the gallbladder with no malignant potential and may involve the gallbladder in a focal, segmental, or diffuse form.
Etiology of cholesterolosis is unknown. Cholesterolosis is a local phenomenon unrelated to atherosclerosis. Triglycerides and cholesterol esters are deposited in the lamina propria of the gallbladder wall. Grossly, the lipid deposits are visible, lending the gallbladder wall a strawberry-like appearance—hence, the term strawberry gallbladder. The deposits vary in size and can be as large as 1 cm.
Frequency
United States
Adenomyomatosis is seen in 5% of cholecystectomies.
Mortality/Morbidity
Patients present with abdominal pain.
Race
No racial predilection is reported for adenomyomatosis.
Sex
Adenomyomatosis occurs more commonly in females.
Age
Adenomyomatosis occurs in patients with a mean age of 53 years (26-86 y). Case reports exist of occurrences in pediatric patients.
Anatomy
The normal gallbladder lies in the gallbladder fossa. The neck of the gallbladder has a constant relationship with the right portal vein, which helps localize the gallbladder on imaging studies. The normal gallbladder wall is composed of 4 layers: the mucosa, lamina propria, an irregular muscle layer, and connective tissue. Surface epithelium is composed of a single layer of columnar epithelium with basal nuclei and eosinophilic cytoplasm. No muscularis mucosa or submucosa exists. Along the hepatic surface, connective tissue is continuous with interlobular connective tissue of the liver.4
Presentation
Patients usually present with vague abdominal pain and usually are treated symptomatically. Cholecystectomy rarely is performed to treat adenomyomatosis.
Preferred Examination
Ultrasound (US) is the preferred radiologic examination. Oral cholecystogram can be used to diagnose adenomyomatosis; however, use of US and MRI is preferred. MRI, CT, and positron emission tomography (PET) can be used as problem-solving modalities, especially to differentiate hyperplastic cholecystosis from gallbladder carcinoma.5,6,7,2,8,9,10,11,12,13,14
Limitations of Techniques
Occasionally, US cannot differentiate between the segmental type of adenomyomatosis and gallbladder carcinoma.
Differential Diagnoses
Carcinoid, Gastrointestinal
Gallbladder, Carcinoma
Other Problems to Be Considered
Differential diagnosis for tumors manifesting as intraluminal polypoid masses includes adenomatous, hyperplastic, and cholesterol polyps; carcinoid tumor; metastatic melanoma; and hematoma within the gallbladder.
Differential diagnosis for a mass replacing the gallbladder fossa includes hepatocellular carcinoma, cholangiocarcinoma, metastatic disease to the gallbladder fossa, and xanthogranulomatous cholecystitis.
More on Adenomyomatosis |
Overview: Adenomyomatosis |
| Imaging: Adenomyomatosis |
| Multimedia: Adenomyomatosis |
| References |
| Further Reading |
| Next Page » |
References
Boscak AR, Al-Hawary M, Ramsburgh SR. Best cases from AFIP:Adenomyomatosis of the gallbladder. Radiographics. 2006;3:941-946.
Ching BH, Yeh BM, Westphalen AC, Joe BN, Qayyum A, Coakley FV. CT differentiation of adenomyomatosis and gallbladder cancer. AJR Am J Roentgenol. Jul 2007;189(1):62-6. [Medline].
Owen CC, Bilhartz LE. Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis. Semin Gastrointest Dis. Oct 2003;14(4):178-88. [Medline].
Harrow AR. The gallbladder and biliary tree. In: Dogra V, Rubens DJ, eds. Ultrasound Secrets. Philadelphia, Pa: Hanley & Belfus; 2003: 119-20. [Medline].
Ash-Miles J, Roach H, Virjee J, Callaway M. More than just stones: a pictorial review of common and less common gallbladder pathologies. Curr Probl Diagn Radiol. Sep-Oct 2008;37(5):189-202. [Medline].
Stunell H, Buckley O, Geoghegan T, O'Brien J, Ward E, Torreggiani W. Imaging of adenomyomatosis of the gall bladder. J Med Imaging Radiat Oncol. Apr 2008;52(2):109-17. [Medline].
Poonam Y, Ashu S, Rohini G. Clinics in diagnostic imaging (121). Gallbladder adenomyomatosis. Singapore Med J. Mar 2008;49(3):262-4; quiz 265. [Medline].
Catalano OA, Sahani DV, Kalva SP, Cushing MS, Hahn PF, Brown JJ, et al. MR imaging of the gallbladder: a pictorial essay. Radiographics. Jan-Feb 2008;28(1):135-55; quiz 324. [Medline].
Chao C, Hsiao HC, Wu CS, Wang KC. Computed tomographic finding in adenomyomatosis of the gallbladder. J Formos Med Assoc. Apr 1992;91(4):467-9. [Medline].
Franquet T, Bescos JM, Barberena J, Montes M. Acoustic artifacts and reverberation shadows in gallbladder sonograms: their cause and clinical implications. Gastrointest Radiol. Summer 1990;15(3):223-8. [Medline].
Hwang JI, Chou YH, Tsay SH, et al. Radiologic and pathologic correlation of adenomyomatosis of the gallbladder. Abdom Imaging. Jan-Feb 1998;23(1):73-7. [Medline].
Kim MJ, Oh YT, Park YN, et al. Gallbladder adenomyomatosis: findings on MRI. Abdom Imaging. Jul-Aug 1999;24(4):410-3. [Medline].
Levy AD, Murakata LA, Rohrmann CA Jr. Gallbladder carcinoma: radiologic-pathologic correlation. Radiographics. Mar-Apr 2001;21(2):295-314; questionnaire, 549-55. [Medline].
Yoshimitsu K, Honda H, Jimi M, et al. MR diagnosis of adenomyomatosis of the gallbladder and differentiation from gallbladder carcinoma: importance of showing Rokitansky-Aschoff sinuses. AJR Am J Roentgenol. Jun 1999;172(6):1535-40. [Medline].
Alberti D, Callea F, Camoni G, et al. Adenomyomatosis of the gallbladder in childhood. J Pediatr Surg. Sep 1998;33(9):1411-2. [Medline].
Ishizuka D, Shirai Y, Tsukada K, Hatakeyama K. Gallbladder cancer with intratumoral anechoic foci: a mimic of adenomyomatosis. Hepatogastroenterology. Jul-Aug 1998;45(22):927-9. [Medline].
Koh T, Taniguchi H, Kunishima S, Yamagishi H. Possibility of Differential Diagnosis of Small Polypoid Lesions in the Gallbladder Using FDG-PET. Clin Positron Imaging. Sep 2000;3(5):213-218. [Medline].
Further Reading
Related eMedicine topics
Bedside Ultrasonography, Gallbladder Disease
Gallbladder Disease
Gallbladder Mucocele
Empyema, Gallbladder
Porcelain Gallbladder
Gallbladder Cancer
Gallbladder, Carcinoma
Clinical Guidelines
ACR Appropriateness Criteria Right Upper Quadrant Pain
Clinical studies
Gallbladder Cholesterolosis, Body Mass Index and Serum Cholesterol and Triglycerides
Keywords
adenomyomatosis, hyperplastic cholecystosis, cholesterolosis, Rokitansky-Aschoff sinuses






Overview: Adenomyomatosis