Adenomyomatosis

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[edit] Discussion of Adenomyomatosis

  • Adenomyomatosis is a benign hyperplastic cholecystosis.
  • It is a relatively common condition (identified in at least 5% of cholecystectomy specimens).
  • Most diagnoses are made in patients in their 50s
  • Adenomyomatosis is most often an incidental finding, has no intrinsic malignant potential, and usually requires no treatment.
  • Cholesterolosis, the other hyperplastic cholecystosis, consists of deposition of triglycerides and cholesterol esters within the lamina propria, producing a characteristic gross appearance known as "strawberry gallbladder."
  • Cholesterol accumulation in adenomyomatosis is intraluminal, as cholesterol crystals precipitate in the bile trapped in Rokitansky-Aschoff sinuses (intramural diverticula lined by mucosal epithelium).
  • Gallbladder involvement by adenomyomatous hyperplasia is variable in extent and location, with heterogeneous imaging appearances corresponding to diffuse, segmental, and focal adenomyomatosis.
    • Exclusion of [gallbladder cancer] may be most problematic in segmental and focal cases
    • Focal adenomyomatosis may appear as a discrete mass, known as an adenomyoma.
    • Metabolic characterization with PET may be a useful adjunct in problematic cases.

[edit] Imaging Findings for Adenomyomatosis

[edit] US

  • Echogenic intramural foci from which emanate V-shaped comet tail reverberation artifacts are highly specific for adenomyomatosis, representing the unique acoustic signature of cholesterol crystals within the lumina of Rokitansky-Aschoff sinuses.

[edit] CT

  • Abnormal gallbladder wall thickening and enhancement are common but nonspecific CT features of adenomyomatosis.
  • Rokitansky-Aschoff sinuses of sufficient size can be visualized; a CT rosary sign has been described, formed by enhancing epithelium within intramural diverticula surrounded by the relatively unenhanced hypertrophied gallbladder muscularis.

[edit] MR

  • The pearl necklace sign alludes to the characteristically curvilinear arrangement of multiple rounded hyperintense intraluminal cavities visualized at T2-weighted MR imaging and MR cholangiopancreatography of adenomyomatosis.


[edit] Images

Patient #1

Patient #2: MRI images demonstrate adenomyomatosis at the gallbladder fundus

[edit] See Also


[edit] External Links

[edit] References for Adenomyomatosis