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Abdomen » Hepatobiliary
Adenomyomatosis (adenomyomatous hyperplasia) of the gallbladder
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Author(s) :
Danilo Sirigu, MD
 
Presentation A 62 year old woman presents with recurrent abdominal pain in the right upper quadrant associated with abdominal distention and vomiting .
 
 
Caption: Transabdominal imaging of the gallbladder
Description: Cholelithiasis. The gallbladder also exhibits a focal wall thickening in the fundus. The focal mass contains a brightly echogenic focus which gives rise to a distal comet-tail artifact.
 
 
Caption: Color Doppler of the gallbladder
Description: Color Doppler shows a twinkle artifact and no significant blood flow within the fundal mass.
 
 
 
Caption: Transverse gallbladder fundus
Description: A static image shows the fundal mass with highly echogenic foci within the mass.
 
 
 
Caption: Color Doppler of the mass
Description: Color Doppler demonstrates a twinkle artifact arising from one of the hyperechoic foci within the mass.
 
Differential Diagnosis Adenomyomatosis (adenomyomatous hyperplasia) of the gallbladder
Gallbladder carcinoma
 
Final Diagnosis Cholelithiasis (gallbladder stone) and adenomyomatosis (adenomyomatous hyperplasia) of the gallbladder.
 
Discussion Adenomyomatosis (adenomyomatous hyperplasia) of the gallbladder is a benign process of unknown origin. Pathologically, adenomyomatosis of the gallbladder is defined as epithelial proliferation and hypertrophy of the muscularis of the gallbladder, with outpouching of the mucosa into the thickened muscular layer (Rokitansky-Aschoff sinuses).

Adenomyomatosis of the gallbladder has been classified into three morphologic types:
Diffuse
Segmental
Focal (fundal)
Segmental and focal adenomyomatosis may be difficult to differentiate from gallbladder carcinoma. Although essentially a benign condition, a few cases of associated malignant transformation have been reported, usually in patients with associated anomalous insertion of the pancreatic duct.


For additional information:
http://emedicine.medscape.com/article/363728-overview   EMedicine article by Vikram Dogra, MD

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Case References
  1. Boscak AR, Al-Hawary M, Ramsburgh SR. Best cases from AFIP:Adenomyomatosis of the gallbladder. Radiographics. 2006;3:941-946.
  2. Maldjian et al .Adenomyomatosis of the Gallbladder: Another Cause for a "Hot" Gallbladder on 18F-FDG. Am. J. Roentgenol..2007; 189: W36-W38
  3. Fowler RC, Reid WA. 1988 Ultrasound diagnosis of adenomyomatosis of the gallbladder: ultrasonic and pathological correlation. Clinical Radiology 39: 402–406.
  4. Tanno S, Obara T, Maguchi H et al. 1998 Association between anomalous pancreatobiliary ductal union and adenomyomatosis of the gallbladder. Journal of Gastroenterology and Hepatology 13: 175–180
 
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