eMedicine Specialties > Radiology > Gastrointestinal

Adenomyomatosis

Author: Vikram S Dogra, MD, Professor of Diagnostic Radiology, Urology, and Biomedical Engineering, University of Rochester School of Medicine; Director, Division of Ultrasound, Associate Chair of Education and Research, Department of Imaging Sciences, University of Rochester Medical Center
Contributor Information and Disclosures

Updated: Jul 21, 2009

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 hype...

Longitudinal sonogram of gallbladder shows a hyperechoic focus in the anterior wall with reverberation artifact, which is characteristic of hyperplastic cholecystosis.

[ CLOSE WINDOW ]
Longitudinal sonogram of gallbladder shows a hype...

Longitudinal sonogram of gallbladder shows a hyperechoic focus in the anterior wall with reverberation artifact, which is characteristic of hyperplastic cholecystosis.



Oral cholecystogram shows focal fundal thickening...

Oral cholecystogram shows focal fundal thickening in a patient with focal fundal adenomyomatosis.

[ CLOSE WINDOW ]
Oral cholecystogram shows focal fundal thickening...

Oral cholecystogram shows focal fundal thickening in a patient with focal fundal adenomyomatosis.



Sonogram in a patient with adenomyomatosis. Same ...

Sonogram in a patient with adenomyomatosis. Same patient as in Image 4.

[ CLOSE WINDOW ]
Sonogram in a patient with adenomyomatosis. Same ...

Sonogram in a patient with adenomyomatosis. Same patient as in Image 4.



 

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
[ CLOSE WINDOW ]

References

  1. Boscak AR, Al-Hawary M, Ramsburgh SR. Best cases from AFIP:Adenomyomatosis of the gallbladder. Radiographics. 2006;3:941-946.

  2. 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].

  3. Owen CC, Bilhartz LE. Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis. Semin Gastrointest Dis. Oct 2003;14(4):178-88. [Medline].

  4. Harrow AR. The gallbladder and biliary tree. In: Dogra V, Rubens DJ, eds. Ultrasound Secrets. Philadelphia, Pa: Hanley & Belfus; 2003: 119-20. [Medline].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. Kim MJ, Oh YT, Park YN, et al. Gallbladder adenomyomatosis: findings on MRI. Abdom Imaging. Jul-Aug 1999;24(4):410-3. [Medline].

  13. Levy AD, Murakata LA, Rohrmann CA Jr. Gallbladder carcinoma: radiologic-pathologic correlation. Radiographics. Mar-Apr 2001;21(2):295-314; questionnaire, 549-55. [Medline].

  14. 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].

  15. Alberti D, Callea F, Camoni G, et al. Adenomyomatosis of the gallbladder in childhood. J Pediatr Surg. Sep 1998;33(9):1411-2. [Medline].

  16. 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].

  17. 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].

[ CLOSE WINDOW ]

Keywords

adenomyomatosis, hyperplastic cholecystosis, cholesterolosis, Rokitansky-Aschoff sinuses

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Vikram S Dogra, MD, Professor of Diagnostic Radiology, Urology, and Biomedical Engineering, University of Rochester School of Medicine; Director, Division of Ultrasound, Associate Chair of Education and Research, Department of Imaging Sciences, University of Rochester Medical Center
Vikram S Dogra, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of Program Directors in Radiology, Radiological Society of North America, Society of Radiologists in Ultrasound, and Society of Uroradiology
Disclosure: Nothing to disclose.

Medical Editor

Eric P Weinberg, MD, Associate Professor, Department of Radiology, University of Rochester Medical Center, Strong Memorial Hospital
Eric P Weinberg, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Arnold C Friedman, MD, FACR, Associate Chairman, Department of Radiology, University of Florida Health Science Center; Chief, Department of Radiology, Shands-Jacksonville Hospital
Arnold C Friedman, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Clinical Director of Radiology and Consultant Radiologist, Department of Radiology, King's College Hospital, London
John Karani, MBBS, FRCR is a member of the following medical societies: British Institute of Radiology, British Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, European Society of Gastrointestinal and Abdominal Radiology, European Society of Radiology, Radiological Society of North America, and Royal College of Radiologists
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.