Controversy and consideration of gallbladder adenomyomatosis / 中华肝胆外科杂志

The detection rate of gallbladder adenomyomatosis has gradually increased, but the accuracy of preoperative diagnosis is low. Most doctors tend to expand the operation indications because they are worried about the carcinogenesis. But there are still great controversies on the key issues such as whether it is cancerous, operation indications and how to follow up for non-surgical patients. This article will review these key issues.

Intracystic Papillary Neoplasm of the Gallbladder Arising from a Localized Adenomyomatous Hyperplasia / 대한췌담도학회지

Adenomyomatous hyperplasia (AMH) of the gallbladder commonly accompanies chronic cholecystitis and may be classified into three types according to the gross features: segmental, localized (fundal), and diffuse types. In situ or invasive carcinomas arising from and confined to AMH are rarely observed, especially of the segmental type. Intracystic papillary neoplasm (IPN) is one of the precancerous lesions of the gallbladder. IPN usually grows into the lumen and produces a polypoid or papillary mass. Here, we report an extremely rare case of IPN arising from and limited to a localized AMH incidentally detected in a brain-dead 68-year-old female patient during organ harvesting.

Pathogenesis of gallbladder adenomyomatosis and its relationship with early-stage gallbladder carcinoma: an overview

The exact pathogenesis of gallbladder adenomyomatosis is still lacking and some controversies over its diagnosis and treatment exist. Originally recognized as a precancerous lesion, adenomyomatosis is currently recognized by recent studies as a benign alteration of the gallbladder that is often associated with cholecystitis and cholecystolithiasis. Gallbladder carcinoma is an extremely malignant disease with a 5-year survival rate of less than 5%. Therefore, it is important to diagnose, differentiate, and confirm the relationship between adenomyomatosis and early-stage gallbladder carcinoma. However, the early clinical symptoms of adenomyomatosis are extremely similar to those of gallbladder stones and cholecystitis, increasing the difficulty to identify and treat this disease. This article summarizes the research progress on gallbladder adenomyomatosis, aiming to improve the understanding of the pathogenesis of adenomyomatosis and further provide insight for its clinical diagnosis and treatment.

Hallazgos clínicos e histopatológicos en pacientes con adenomiomatosis vesicular / Clinical and histopathological findings in patients with gallblader adenomyomatosis

Objetivo: El objetivo del estudio es describir la presentación clínica e histopatológica de la adenomiomatosis vesicular en una serie de pacientes colecistectomizados. Material y método: Entre el 1 de enero del 2010 y el 30 abril del 2015 se realizaron 6.957 colecistectomías, diagnosticándose adenomiomatosis en 95 de las vesículas extirpadas (1,4%). Se describen los hallazgos clínicos e histopatológicos en estos pacientes. Resultados: En 53 pacientes (55,8%) se presentó dolor abdominal. Alteraciones histológicas concomitantes se presentaron en la mucosa vesicular de 34 pacientes (35,8%), siendo la metaplasia pilórica la más frecuente (21%); y en 8 pacientes (8,4%) se presentó displasia de alto y bajo grado. Las patologías asociadas más frecuentes fueron colelitiasis 82,1% y colecistitis crónica 85,3%. Conclusiones: En la serie estudiada se observaron diversas alteraciones histológicas, incluyendo la displasia de alto grado. La colelitiasis se presentó con una frecuencia elevada.

Aim: The aim of the study was to describe the clinical and histopathologic presentation of adenomyomatosis (ADM) of the gallbladder in a series of patients. Material and method: Between January 1, 2010 to April 30, 2015, 6957 patients underwent cholecystectomy. Among them, ADM was diagnosed in 95 of cholecystectomy specimens (1.4%). Clinical and pathological findings in these patients are described. Results: In 53 patients (55.8%) presented abdominal pain. Concomitant histological changes occurred in the gallbladder mucosa of 34 patients (35.8%), being the most frequent pyloric metaplasia (21%); and in 8 patients (8.4%) high-grade dysplasia and low-grade dysplasia was presented. The most frequent associated pathologies were cholelithiasis in 82.1%, and chronic cholecystitis in 85.3%. Conclusions: In this serie, various histological changes were observed, including high-grade dysplasia. Cholelithiasis was presented with high frequency.

Fundal Variant of Adenomyomatosis of the Gall Bladder: An Uncommon Entity.

Adenomyomatosis of the gallbladder is a benign and degenerative condition of the gallbladder. It is an incidental finding in gall bladder specimens resected for chronic cholecystitis or cholelithiasis. It frequently occurs after 3rd or 4th decade of life and is often an incidental finding in cholecystectomy specimens resected for chronic cholecystitis or cholelithiasis. Patients with adenomyomatosis are usually asymptomatic it can be classified into three types: Segmental, fundal and diffuse types. The fundal variant is uncommon compared to the other two types. Here, in we present a case of a fundal variant of adenomyomatosis of the gall bladder in a 65-year-old male patient.

The value of dual-phase enhanced MSCT scan with reconstruction technique for distinguishing adenomyomatosis from gallbladder cancer / 实用放射学杂志

Objective To study the value of dual-phase enhanced multi-slice computed tomography (MSCT)scan in combination with the reconstruction technique for distinguishing gallbladder adenomyomatosis (GBA)from gallbladder cancer.Methods We ret-rospectively reviewed the CT features (including dual-phase and reconstructed images)of 36 patients with GBA (Group A,1 6 pa-tients)or gallbladder cancer (Group B,20 patients)proved by pathology.Fisher exact test was used to compare the CT findings be-tween the two groups.Results The occurrence rates of RAS,gallbladder wall smoothing,clear gallbladder border,uniform en-hancement of serous layer and thickening of the gallbladder wall were statistically significantly different between Group A and B. When using the Rokitansky-Aschoff sinuses as a parameter for the differential diagnosis of the two groups,the diagnostic accuracy reached to 92.85%.Conclusion Dual-phase enhanced MSCT scan in combination with the reconstruction technique is a valuable ima-ging technique for distinguishing GBA from gallbladder cancer.

Diagnostic values of ultrasonography and CT for gallbladder adenomyomatosis:a comparative analysis / 临床肝胆病杂志

Objective To analyze the diagnostic values of ultrasonography and computed tomography (CT)for gallbladder adenomyomatosis. Methods The ultrasound and CT findings of 28 cases of pathologically confirmed gallbladder adenomyomatosis in our hospital were retrospectively analyzed.The diagnostic values of the two imaging tools for gallbladder adenomyomatosis were analyzed with the pathological diagnosis as the gold standard.Comparison of rates was made by chi-square test;multiple comparisons of rates were made by partition of chi-square.Results Before operation,among the 28 patients,15 were diagnosed with gallbladder adenomyomatosis by ultrasonography,and 9 were diagnosed by CT;the diag-nostic rate of CT was 32.14%,and the diagnostic rate of ultrasonography was 53.57%.The chi-square test showed no difference between the di-agnostic rates of ultrasonography and CT for gallbladder adenomyomatosis (χ2 =2.63,P=0.10>0.05).In addition,the statistical results showed no differences between the diagnostic rates of ultrasonography and CT for various types of gallbladder adenomyomatosis (segmental type:χ2 =0,P=0.11>0.0125;diffuse type:χ2 =2.57,P=1.00>0.0125;focal type:χ2 =1.42,P=0.23>0.0125).Conclusion CT and ultrasonography are two important imaging methods for the diagnosis of gallbladder adenomyomatosis.The detection rate of gallbladder adenomyomatosis can be in-creased through the combination of convex array probe and linear array probe in ultrasonography.

Imaging features of fundus adenomyomatosis of the gallbladder / 中华消化外科杂志

Adenomyomatosis of the gallbladder (GAM) is an acquired,benign proliferative lesion of the gallbladder which is characterized by mucosal proliferation with invaginations and diverticula penetrating into the thickened muscular layer (Rokitansky-Aschoff sinuses).GAM consists of 3 types:diffuse,segmental and fundus GAM.There is no specific presentation of GAM,and computed tomography is helpful for the diagnosis of this disease.From July 2010 to May 2013,16 patients with fundus GAM were admitted to the Second People's Hospital of Wuxi.Rokitansky-Aschoff sinuses and calotte sign at the thickened muscular layer of the fundus of the gallbladder are the typical presentation of the fundus GAM.Enhanced computed tomography examination is of great importance for the diagnosis of the fundus GAM.

Focal Thickening at the Fundus of the Gallbladder: Computed Tomography Differentiation of Fundal Type Adenomyomatosis and Localized Chronic Cholecystitis

BACKGROUND/AIMS: The objective of our study was to identify useful computed tomography (CT) findings for differentiating fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder. METHODS: We retrospectively identified cases of 41 patients with pathologically proven adenomyomatosis (n=21) or chronic cholecystitis (n=20) who had fundal thickening of the gallbladder on preoperative abdominal CT. Analysis of the CT findings included evaluation of the thickness, contour, border, intralesional cystic area, adjacent gallbladder wall thickening, presence of inner layer enhancement, enhancement grade, enhancement pattern, and presence of stones. Statistical analyses were performed using the Mann-Whitney U test and Fisher exact test. RESULTS: Oval contour, inner layer enhancement and intralesional cystic area were more frequently noted in adenomyomatosis than in chronic cholecystitis (p<0.05 for each finding). Flat contour and adjacent gallbladder wall thickening were more frequently observed in chronic cholecystitis than in adenomyomatosis. No differences between adenomyomatosis and chronic cholecystitis in terms of the thickness, enhancement grade, enhancement pattern and presence of stones were apparent. CONCLUSIONS: CT may help to differentiate fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder.

Differentiating between Adenomyomatosis and Gallbladder Cancer: Revisiting a Comparative Study of High-Resolution Ultrasound, Multidetector CT, and MR Imaging

OBJECTIVE: To compare the diagnostic performance of high-resolution ultrasound (HRUS) with contrast-enhanced CT and contrast-enhanced magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) to differentiate between adenomyomatosis (ADM) and gallbladder cancer (GBCA). MATERIALS AND METHODS: Forty patients with surgically proven ADM (n = 13) or GBCA at stage T2 or lower (n = 27) who previously underwent preoperative HRUS, contrast-enhanced CT, and contrast-enhanced MRI with MRCP were retrospectively included in this study. According to the well-known diagnostic criteria, two reviewers independently analyzed the images from each modality separately with a five-point confidence scale. The interobserver agreement was calculated using weighted kappa statistics. A receiver operating characteristic curve analysis was performed and the sensitivity, specificity, and accuracy were calculated for each modality when scores of 1 or 2 indicated ADM. RESULTS: The interobserver agreement between the two reviewers was good to excellent. The mean Az values for HRUS, multidetector CT (MDCT), and MRI were 0.959, 0.898, and 0.935, respectively, without any statistically significant differences between any of the modalities (p > 0.05). The mean sensitivity of MRI with MRCP (80.8%) was significantly higher than that of MDCT (50.0%) (p = 0.0215). However, the mean sensitivity of MRI with MRCP (80.8%) was not significantly different from that of HRUS (73.1%) (p > 0.05). The mean specificities and accuracies among the three modalities were not significantly different (p > 0.05). CONCLUSION: High-resolution ultrasound and MRI with MRCP have comparable sensitivity and accuracy and MDCT has the lowest sensitivity and accuracy for the differentiation of ADM and GBCA.

Role of MRI for the diagnosis of adenomyomatosis of gallbladder / 中国医师杂志

Objective To study of manifestation of adenomyomatosis of gallbladder from MRI and to improve its accuracy of diagnosis .Methods MR features of 24 cases with adenomyomatosis of gallblad-der from 2006 to 2008 proved by operation and pathology were analysed retrospectively .Results Among 24 patients, 20 cases were diagnosed correctly before operation ,four were misdiagnosed as Chronic cholecysti-tis and carcinoma of gallbladder respectively; all cases of gallbladder wall increased thickness from 5 to 12mm (7mm average).Among them, the gallbladder -wall was thickened as limited type in fourteen cases , segment type in eight cases and diffuse type in two cases .And classical Rokitansky-Aschoff sinuses were clearly displayed in 20 cases by lamina T2WI from MRI .Conclusion MRI might has higher diagnostic value in diagnosing of adenomyomatosis of gallbladder .

The diagnosis and treatment of adenomyomatosis of the gallbladder / 中华普通外科杂志

Objective To investigate the clinical feature and treatment of adenomyomatosis of the gallbladder(GBA).Methods Thirty-three cases of GBA admitted from 1992 to 2007 were reviewed retrospectively and their clinical characters were sununarized. Results These cases were divided into three types grossly:14 cages of diffuse type,10 cases of segmental type and 9 Cages of localized type.Cholelithiasis wag associated in 21 cases and 11 cases with cholecystitis.Main clinical presentations included pain in the upper abdomen,discomfort after meal,nausea and vomit.Preoperative correct diagnosis was achieved in only six cases.Twenty-eight patients underwent laparoscopic cholecystectomy and three did open cholecystectomy.Concomirant exploration of common bile duct with T tube drainage and resection of liver ansioma was performed in one each.Adenomyomatosis of the gallbladder was diagnosed by pathologic examination in all cases. Condusions Due to the high rate of combination with cholelithiasis and cholecystitis,GBA has no specific clinical manifestations.The preoperative diagnosis lies on radiological examinations.Cholecystectomy is an appropriate treatment as adenomyomatesis of the gallbladder has a malignant potential.

A Case of Anomalous Union of Pancreaticobiliary Drain with Choledochal Cyst and Adenomyomatosis of the Gallbladder / 대한소화기내시경학회지

Anomalous union of pancraeticobiliary drain (AUPBD) is uncommon anomaly of the pancreaticobiliary ductal union system. Usually, this anomaly is confirmed by long common channel (>15 mm) at ERCP and is divided into according to relationship between pancreatic duct and common bile duct. Recently several reports showed that AUPBD may be associated with congenital choledochal cyst and gallbladder carcinoma. A 33-year old man was admitted with RUQ pain and jaundice. Ultrasonography, Abdominal CT, ERCP, and PTBD cholangiography showed type I choledochal cyst, AUPBD and focal adenomyomatosis on the gallbladder. Whipple's operation with excision of the choledochal cyst and chloecystectomy were performed for treatment. This clinical experience suggests that high incidence of choledochal cyst in patients with AUPBD and gallbladder adenomyomatosis are may be closely related to the carcinogenesis of gallbladder cancer in patients with AUPBD.

Two Cases of Gallbladder Diseases Diagnosed with Double Contrast Study of the Gallbladder / 대한소화기내시경학회지

With the developement of the conventional abdominal ultrasound, many asymptomatic gallbladder diseases are noted. The combined diagnostic modalities using abdominal ultrasound, endoscopic ultrasound and endoscopic retrograde cholangiopanereatography are useful for the diagnosis of gallbladder diseases, especially polypoid lesions. But, diagnostic accuracy or ability is not satisfactory for the detection of early gallbladder cancer, among which there are increasing trends of flat or superficial type. Many efforts were tried to diagnose these lesions through the variable methods by direct access to the gallbladder, such as percutaneous transhepatic cholecystoscopy(PTCCS). With the advent of cystic duct cannulation method, endoscopic cholecystoduodenal stenting or nasocholecystic drainage come to be available for the treatment of acute suppurative cholecystitis. Via this route, double contrast study with barium sulfate and CO2 showed fine reticular mucosal structures of the gallbladder and increased diagnostic accuracy af the flat type cancer. We report 2 cases of gallbladder diseases with early cancer confined to the mucosa and adenomyomatous hyperplasia. They were diagnosed by the double contrast method of gallbladder that was firstly introduced domestically by us after endoscopic cannulation of cystic duct and pla~eement of the catheter to the gallbladder.

Two Cases of Gallbladder Diseases Diagnosed with Double Contrast Study of the Gallbladder / 대한소화기내시경학회지

With the developement of the conventional abdominal ultrasound, many asymptomatic gallbladder diseases are noted. The combined diagnostic modalities using abdominal ultrasound, endoscopic ultrasound and endoscopic retrograde cholangiopanereatography are useful for the diagnosis of gallbladder diseases, especially polypoid lesions. But, diagnostic accuracy or ability is not satisfactory for the detection of early gallbladder cancer, among which there are increasing trends of flat or superficial type. Many efforts were tried to diagnose these lesions through the variable methods by direct access to the gallbladder, such as percutaneous transhepatic cholecystoscopy(PTCCS). With the advent of cystic duct cannulation method, endoscopic cholecystoduodenal stenting or nasocholecystic drainage come to be available for the treatment of acute suppurative cholecystitis. Via this route, double contrast study with barium sulfate and CO2 showed fine reticular mucosal structures of the gallbladder and increased diagnostic accuracy af the flat type cancer. We report 2 cases of gallbladder diseases with early cancer confined to the mucosa and adenomyomatous hyperplasia. They were diagnosed by the double contrast method of gallbladder that was firstly introduced domestically by us after endoscopic cannulation of cystic duct and pla~eement of the catheter to the gallbladder.