From the Guidelines
Gallbladder adenomyomatosis is a benign condition that typically requires no specific treatment, and management is usually focused on alleviating symptoms if they occur, with surgical removal of the gallbladder only recommended in severe cases or when cancer cannot be ruled out. This condition is characterized by an overgrowth of the gallbladder wall's muscle tissue (hypertrophy) and outpouching of the inner lining (Rokitansky-Aschoff sinuses) 1. The exact cause of adenomyomatosis remains unknown, but it may involve increased pressure within the gallbladder leading to muscle thickening and mucosal herniation over time.
Some key points to consider in the management of gallbladder adenomyomatosis include:
- The condition is usually asymptomatic and discovered incidentally during imaging for other conditions
- If symptoms occur, such as right upper quadrant pain, they can typically be managed with pain medications like acetaminophen or NSAIDs as needed
- Dietary modifications, including reducing fatty foods, may help minimize symptoms
- Regular monitoring with ultrasound every 6-12 months may be recommended in some cases to ensure stability, particularly for larger lesions (>10mm) or those with rapid growth 1
- The condition occurs in about 2-5% of the population and is more common in middle-aged and older adults
It's worth noting that while adenomyomatosis itself is not dangerous, there is a need to differentiate it from other conditions, such as gallbladder cancer, which may have a similar presentation. However, the evidence from the provided studies does not support a significant association between adenomyomatosis and an increased risk of gallbladder cancer 1. Therefore, the focus should be on managing symptoms and monitoring for any changes in the condition, rather than on aggressive treatment or screening for cancer.
From the Research
Definition and Characteristics of Gallbladder Adenomyomatosis
- Gallbladder adenomyomatosis is a benign acquired gallbladder disease characterized by excessive epithelial proliferation associated with hypertrophy of muscularis propria, leading to outpouchings of mucosa into or beyond the muscle layer forming intramural diverticula recognized as Rokitansky-Aschoff sinuses (RAS) 2, 3.
- It can mimic cancer on radiological findings, leading to a diagnostic dilemma, and its management and prognosis are entirely different from those of gallbladder cancer 2.
- There are three types of gallbladder adenomyomatosis: fundal, segmental, and diffuse, each with distinct characteristics and implications for diagnosis and treatment 3, 4, 5.
Diagnosis of Gallbladder Adenomyomatosis
- Diagnosis is typically made using imaging techniques such as ultrasound, MRI, and CT scans, which can show thickened gallbladder wall containing cysts, "comet-tail" artefacts, "twinkling" artefacts, "pearl-necklace sign", and "rosary sign" 2, 3, 5.
- High-resolution ultrasound is considered the most efficient radiological examination for diagnosing gallbladder adenomyomatosis 2.
- Histologic examination can also confirm the diagnosis when cholecystectomy is performed 2, 5.
Management and Treatment of Gallbladder Adenomyomatosis
- Symptomatic gallbladder adenomyomatosis is an indication for cholecystectomy, which can result in complete disappearance of symptoms 2, 5.
- Asymptomatic gallbladder adenomyomatosis may not require surgery, but the radiological diagnosis must be beyond any doubt, and cholecystectomy may be considered for segmental or diffuse types due to increased risk of malignancy or difficulty in visualizing coexisting malignancy 3, 4, 5.
- Laparoscopic cholecystectomy is the gold standard for symptomatic gallbladder adenomyomatosis or radiological suspicion of gallbladder cancer 2.