Gallbladder Adenomyomatosis Mimicking Carcinoma: A Diagnostic Dilemma

Symptomatic Gallbladder Adenomyomatosis: A rare clinical presentation

INTRODUCTION AND IMPORTANCE

Gallbladder Adenomyomatosis (GA) is a benign rare condition that is mostly asymptomatic but can present as abdominal pain. GA usually occurs in the middle-aged population with an equal sex distribution.

CASE PRESENTATION

A case of a 49-years-old female who sought medical care several times due to abrupt abdominal pain. She underwent echography, Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) before performing laparoscopic cholecystectomy for symptomatic GA. The pathology report confirmed acalculous cholecystitis in the presence of GA.

CLINICAL DISCUSSION

In fact, echography can reveal the "comet- tail" sign, the CT can show the "rosary sign"; and MRI shows the "pearl necklace" sign. These signs, in the absence of gallstones, can justify the abdominal pain hence the diagnosis of symptomatic GA.

CONCLUSION

GA is being increasingly reported; however, symptomatic cases remain the exception. We believe that awareness to this entity should be raised so that healthcare professionals can establish the diagnosis efficiently.

Imaging update on gallbladder adenomyomatosis and its mimics

Radiologists across many imaging modalities commonly encounter gallbladder adenomyomatosis. The classic imaging appearances of gallbladder adenomyomatosis are well described and confirm benignity. However, in clinical practice, adenomyomatosis can be challenging to differentiate from other gallbladder pathologies that require cholecystectomy. In this article, we describe the common and uncommon appearances of gallbladder adenomyomatosis on multimodality imaging, helping differentiate adenomyomatosis from non-benign gallbladder abnormalities. Accurately differentiating adenomyomatosis from its mimics provides the surgical team with important clinical and surgical management information, improving patient outcomes.

Safra Kesesi Adenomyomatozisi Prekanseröz Lezyon mudur? Ki-67 ve P53 Pozitif Ekspresyonunun Normal Safra Kesesi Dokusu ile Karşılaştırılması

Amaç: Safra kesesi adenomyomatozisinin (SKA) kesin patogenezi hala tam olarak açıklanamamıştır, tanı ve tedavisine ilişkin bazı tartışmalar mevcut. Başlangıçta kanser öncesi bir lezyon olarak kabul edilen adenomyomatozis, son zamanlarda yapılan çalışmalarda safra kesesinin sıklıkla kolesistit ve kolelitiazis ile ilişkili iyi huylu bir değişikliği olarak kabul edilmektedir. Bu çalışmada, SKA patogenezini araştırmak için; aynı hastada safra kesesi normal ve adenomyomatozis dokusunda, tümör hücrelerinin proliferatif aktivitesini gösteren biyobelirteç düzeyleri ve neoplastik doku pozitiflik paternini gösteren biyobelirteç düzeylerinin karşılaştırılması amaçlanmıştır.Yöntem: 2019-2020 yılları arasında toplam 750 laparoskopik kolesistektomi uygulanan hastanın patoloji raporları incelenmiş, adenomyomatozis tanısı alan 20 vaka retrospektif olarak değerlendirilmiştir. Proliferasyon belirteci olarak Ki-67 ve neoplastik aktivite belirteci olarak P53, safra kesesi normal dokusu ile adenomyomatozis dokusunda ayrı ayrı değerlendirilmiştir.Bulgular: Safra kesesi normal ve adenomyomatozis dokusundaki Ki-67 indeksi ortalama değerleri karşılaştırıldığında, istatistiksel olarak anlamlı fark bulundu (p<0,000). Ancak bu iki grup P53 indeksi ortalama değerleri açısından karşılaştırıldığında istatistiksel fark bulunamadı (p=0,062).Sonuç: Çalışmada adenomyomatozis dokularında anlamlı derecede yüksek Ki-67 proliferasyon belirteci düzeyleri tespit edilmesine karşın, safra kesesi kanserinin yaygın P53-pozitiflik paterninin bu dokularda normal dokularla karşılaştırıldığında anlamlı farklar saptanmaması, SKA’nin kanser öncüsü bir lezyon olmayıp, iyi huylu proliferatif bir değişiklik olduğunu destekler görünmektedir.

Adenomatous Hyperplasia of the Gallbladder in the Setting of Mirizzi Syndrome, Mimicking Adenocarcinoma of the Gallbladder

Background

Adenomatous hyperplasia (AH) is an uncommon benign lesion of the gallbladder (GB), predominantly seen in men. AH is commonly confused with malignant GB neoplasms in the setting of chronic cholecystitis and gallstones. There is a scarcity of published literature on AH, suggesting its rarity and the need for this case report.

Case Presentation

A 24-year-old woman from Western Uganda presented with signs and symptoms consistent with extrahepatic biliary obstruction. Trans-abdominal ultrasound scan revealed cholecystomegaly (13.9 cm by 4.29 cm), thickened GB wall at 5.2 mm, with a poorly defined hypoechoic polypoid solid mass involving the fundal body of the GB. Explorative laparotomy with cholecystectomy and lymph node sampling was performed. Histopathological examination was consistent with adenomatous hyperplasia of the GB. The symptoms and laboratory values improved on follow-up in the clinic after laparotomy.

Conclusion

Adenomatous hyperplasia may be misdiagnosed as a malignant GB neoplasm, especially in the setting of chronic cholecystitis and gallstones. If a correct histopathological diagnosis is made, no further diagnostic work-up is necessary following surgical interventions.

Gallbladder adenomyomatosis: Diagnosis and management

INTRODUCTION

Gallbladder adenomyomatosis is a benign acquired gallbladder disease. It can mimic cancer on radiological findings, leading to a diagnostic dilemma. The management and prognosis of these two gallbladder anomalies are entirely different. Therefore, it is essential to recognize the pathognomonic features of gallbladder adenomyomatosis is in order to accurately diagnose this pathology. This paper presents two encountered cases of gallbladder adenomyomatosis is, their diagnostic modalities as well as the algorithmic approach of their management. These two-case reports have been reported in line with the SCARE Criteria 2020 [1].

PRESENTATION OF CASE

Patient-1 was symptomatic. He was explored by an abdominal ultrasound picturing gallbladder wall thickening while the biopsy showed pleomorphic proliferation of inflammatory cells. An examination of the liver with MRI was indicated, showing diffuse parietal thickening with multiple cystic pockets. He underwent laparoscopic cholecystectomy with simple operative follow-up. Patient 2 was asymptomatic, a staging CT scan of acute pancreatitis revealed focal mural thinking of the gallbladder wall. A liver MRI showed an intramural cystic formation in the vesicular fundus. Given the inconclusive imaging results, laparoscopic cholecystectomy was performed. Histological examination confirmed the diagnosis of GA.

DISCUSSION

Adenomyomatosis is usually asymptomatic. Imaging can confirm the diagnosis of gallbladder adenomyomatosis without the need for invasive procedures such as vesicular biopsy. Histologic examination can also confirm the diagnosis when cholecystectomy is done. High resolution ultra-sound is the most efficient radiological examination. Laparoscopic cholecystectomy is the gold standard for symptomatic GA or radiological suspicion of a gallbladder cancer.

CONCLUSION

The practitioner should always consider gallbladder carcinoma before confirming the GA, as they share the same features but with a far worse prognosis. The likelihood of malignancy depends on radiological characteristics. In the case of inconclusive findings, cholecystectomy is justified.

Diffuse Gallbladder Adenomyomatosis in a Child

Adenomyomatosis of the gallbladder is a benign condition, usually occurring in middle age, in which the epithelium of the gallbladder proliferates and the gallbladder wall thickens with the presence of Rokitansky-Aschoff sinuses (RAS). The diffuse form is an unusual subtype of adenomyomatosis. Herein, we describe a 17-year-old female who presented with dull and intermittent pain in the right hypochondriac region for more than a month. Ultrasound followed by magnetic resonance imaging showed marked diffuse gallbladder wall thickening. A gross cholecystectomy specimen showed a diffusely enlarged gallbladder. The final diagnosis of gallbladder adenomyomatosis (GA) was confirmed by the histopathologic appearance of muscular and epithelial hyperplasia, contributing to mural thickening with epithelial invaginations forming the pathognomonic intramural diverticula known as the RAS. This case highlights that the diffuse form of GA is uncommon and is often accompanied by chronic inflammation, sometimes requiring differential diagnosis from gallbladder malignancies, especially when there is no image showing a “comet tail” of cholesterol crystals in the wall.

Diffuse Gallbladder Adenomyomatosis with an Inflammatory Complication in an Adult

Gallbladder adenomyomatosis (GA) is a benign alteration of the gallbladder wall. There are three types involved: segmental, fundal, and diffuse pattern; the last type is very rare. Ultrasound is the imaging method of choice for diagnosing that shows Rokitansky-Aschoff sinuses with cholesterol deposition creating comet-tail artifacts. Asymptomatic GA does not require surgery in case there are no malignant lesions defined by imaging diagnosis. We present the rare case of a 51-year-old man who was admitted to hospital due to abdominal pain concomitant with inflammatory syndrome. Imaging and histological findings were appropriate to diagnose diffuse GA and complication of cholecystitis.