Background and aim: Adenomatous hyperplasia of the gallbladder or adenomyomatosis is a benign neoplasia characterized by epithelium hyperplasia with invaginations into the subserose forming intramural diverticula (Rokitansky-Aschoff sinuses). It is reported in 1 to 8.5% of cholecystectomies and 7% of autopsies. It has been associated with cholelithiasis in 80% of cases and may have an asymptomatic course or present with biliary cholic. According to its site it can be localized, annular, diffuse or segmental; the later associated with cancer in 3.2%.
Material and methods: Retrospective review of medical records of patients with pathology study diagnosis of adenomyomatosis from January 1st, 2015 through December 31st, 2019.
Results: Twenty-four cases were found, with 58.3% of women and mean age of 51 years. Elective cholecystectomy was found in 26% of cases. Most frequent symptoms were abdominal pain, nausea and, vomit with 75%, 41.7%, and 33.3%, respectively. Duration of symptoms was less than 24hours in 21.1%, and 7 days to 3 months in 57.9% of cases. Smoking was reported in 58.3%, alcohol consumption in 12.5% and dyslipidemia in 20.8% of cases. Murphy's sign was reported in 37.5% and the most frequent clinical diagnosis was acute cholecystitis in 66.7% of cases. Mean alkaline phosphatase was 105.6±76.0 UI/L and mean gamma-glutamyl transpeptidase was 113.2±161.3 UI/L. In abdominal ultrasound, the gallbladder had a thin wall in 50%, thick wall in 8.3%, polyps in 20.8% and stones in 54.2% of cases. In pathology studies, mean thickness of adenomyomatosis was 90.5mm and the location were localized (fundus) in 58.3%, diffuse in 20.8% and annular in 4.2% of cases.
Conclusions: Female sex (estrogens), chronic inflammation (cholecystitis) and cholelithiasis are the few associated factors for the development of adenomyomatosis. Most ultrasound findings are non-specific and, therefore, presurgical diagnosis is difficult. In most of the cases, the diagnosis of adenomyomatosis was an incidental finding associated with acute cholecystitis.
Conflicts of interest: The authors have no conflicts of interest to declare. Funding was sponsored by the authors.
