Gallbladder adenomyomatosis: Diagnosis and management

Area of Science:

• Gastroenterology
• Pathology
• Radiology

Background:

• Gallbladder adenomyomatosis (ADM) is a benign, acquired condition involving mucosal invagination into the muscularis, forming Rokitansky-Aschoff sinuses.
• Chronic gallbladder inflammation is a necessary precursor, with prevalence increasing after age 50.
• ADM affects 1-9% of cholecystectomy specimens and can be asymptomatic or cause pain.

Purpose of the Study:

• To describe the characteristics, diagnosis, and management of gallbladder adenomyomatosis.
• To differentiate ADM from other gallbladder pathologies, including cancer.
• To provide guidance on surgical intervention for ADM.

Main Methods:

• Review of clinical presentation, imaging findings (ultrasound, MRI), and pathological data.
• Analysis of diagnostic criteria for ADM, including characteristic imaging features.
• Evaluation of treatment outcomes for symptomatic and asymptomatic ADM.

Main Results:

• ADM presents in segmental, fundal, or diffuse forms, often without gallstones.
• Ultrasound shows intra-parietal pseudo-cysts and comet tail artifacts; MRI reveals a "pearl necklace" sign.
• Symptomatic ADM resolves completely after cholecystectomy.

Conclusions:

• Symptomatic ADM necessitates cholecystectomy for symptom resolution.
• Asymptomatic ADM requires no surgery unless diagnostic doubt regarding cancer exists.
• Incidental ADM findings in surgical specimens do not warrant further surveillance.