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.
 Imaging Findings for Adenomyomatosis
- 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.
- 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.
- 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.
Patient #2: MRI images demonstrate adenomyomatosis at the gallbladder fundus
 See Also
 External Links
 References for Adenomyomatosis
- Alexis R. Boscak, Mahmoud Al-Hawary, and Stephen R. Ramsburgh. Best Cases from the AFIP: Adenomyomatosis of the Gallbladder. RadioGraphics 2006 26: 941-946.