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, as defined in the 2022 Radiology study 1. This condition is often discovered incidentally during imaging studies, and most people with adenomyomatosis have no symptoms. When symptoms do occur, they may include:
- Right upper quadrant pain
- Nausea
- Discomfort similar to gallstone symptoms The exact cause of adenomyomatosis remains unknown, though it's thought to result from increased pressure within the gallbladder leading to muscle thickening and epithelial outpouching, as suggested by the definitions provided in the study 1. Key characteristics of adenomyomatosis include:
- Mural hyperplasia
- Comet-tail artifact or twinkling artifact due to intramural cholesterol crystals
- Rokitansky-Aschoff sinuses appearing as intramural cysts Treatment is generally not necessary for asymptomatic cases, but surgical removal of the gallbladder (cholecystectomy) may be recommended if symptoms are troublesome or if there's concern about potential complications or difficulty distinguishing it from gallbladder cancer, as implied by the study's discussion on gallbladder polyps and carcinomas 1. Regular monitoring with ultrasound is sometimes suggested for asymptomatic cases to ensure stability of the condition.
From the Research
Definition and Characteristics of Adenomyomatosis
- Adenomyomatosis is a benign acquired gallbladder disease characterized by hypertrophy of the mucosal epithelium that invaginates into the interstices of a thickened muscularis, forming Rokitansky-Aschoff sinuses 2.
- It is a hyperplastic disease affecting the wall of the gallbladder, with some typical features 3.
- Adenomyomatosis can be classified into three forms: segmental, fundal, and diffuse 2.
Clinical Presentation and Diagnosis
- Adenomyomatosis is usually asymptomatic, but it can manifest as abdominal pain or hepatic colic, even in the absence of associated gallstones 2.
- The diagnosis of adenomyomatosis is based mainly on ultrasound (US), which identifies intra-parietal pseudo-cystic images and "comet tail" artifacts 2.
- MRI with MRI cholangiography sequences is the reference examination with characteristic "pearl necklace" images 2.
- High-resolution ultrasound is the most efficient radiological examination for diagnosing adenomyomatosis 4.
Management and Treatment
- Symptomatic adenomyomatosis is an indication for cholecystectomy, which results in complete disappearance of symptoms 2.
- Asymptomatic adenomyomatosis is not an indication for surgery, but the radiological diagnosis must be beyond any doubt 2.
- If there is any diagnostic doubt about the possibility of gallbladder cancer, a cholecystectomy is justified 4, 2.
- Laparoscopic cholecystectomy is the gold standard for symptomatic adenomyomatosis or radiological suspicion of gallbladder cancer 4.
Rare Occurrences and Diagnostic Challenges
- Adenomyomatosis can occur in the bile duct, which is a rare but significant condition that can cause biliary obstruction, cholestasis, and abdominal pain 5.
- The occurrence of adenomyomatosis in the bile duct can create diagnostic challenges and increase the risk of misdiagnosis and overtreatment, making accurate identification essential 5.