From the Guidelines
Adenomyomatosis is a benign condition characterized by mural hyperplasia with comet-tail artifact or twinkling artifact due to intramural cholesterol crystals, and Rokitansky-Aschoff sinuses appearing as intramural cysts. This condition is defined as a non-cancerous growth of the gallbladder's muscle layer and an abnormal infolding of the inner lining, creating small pockets 1.
Key Characteristics
- Mural hyperplasia that may be diffuse, focal, or segmental
- Comet-tail artifact or twinkling artifact due to intramural cholesterol crystals
- Rokitansky-Aschoff sinuses appearing as intramural cysts
Diagnosis and Treatment
Adenomyomatosis is often discovered incidentally during imaging studies performed for other reasons 1. The condition can appear in different forms: localized, segmental, or diffuse. No specific treatment is necessary for asymptomatic adenomyomatosis, but if symptoms occur, surgical removal of the gallbladder may be recommended.
Importance of Monitoring
While adenomyomatosis itself is not considered precancerous, regular monitoring through ultrasound or other imaging techniques may be advised to track any changes, especially in cases where it's difficult to distinguish from more serious conditions 1.
From the Research
Definition and Characteristics of Adenomyomatosis
- Adenomyomatosis is a hyperplastic disease affecting the wall of the gallbladder, characterized by excessive epithelial proliferation associated with hypertrophy of muscularis propria 2, 3.
- It is a benign acquired gallbladder disease, but recent reports have highlighted a potential role in predisposing to malignancies of the gallbladder 2, 4.
- The disease has distinctive imaging features, including "comet-tail" artefacts and "twinkling" artefacts on ultrasound, "pearl-necklace sign" on magnetic resonance imaging (MRI), and "rosary sign" on computed tomography (CT) 3, 5.
Types and Prevalence of Adenomyomatosis
- There are three types of adenomyomatosis: fundal, segmental, and diffuse 3, 5.
- The prevalence of adenomyomatosis in cholecystectomy specimens is estimated between 1% and 9%, with a balanced sex ratio, and the incidence increases after the age of 50 5.
- Adenomyomatosis is more common after the age of 35-40 years and among women, according to some studies 6.
Diagnosis and Management of Adenomyomatosis
- Diagnosis of adenomyomatosis is based mainly on ultrasound, which identifies intra-parietal pseudo-cystic images and "comet tail" artifacts 4, 5.
- MRI with MRI cholangiography sequences is the reference examination with characteristic "pearl necklace" images 5.
- Cholecystectomy is indicated for symptomatic adenomyomatosis, and for asymptomatic cases with a high risk of malignancy or difficult visualization of any coexisting malignancy 2, 3, 5.
- Asymptomatic fundal adenomyomatosis can be safely observed with ultrasound, but the frequency and duration of monitoring are unknown 3.