Adenomyomatosis of the gallbladder. Personal experience and analysis of the literature

Gallbladder adenomyomatosis is a pathological condition due to parietal thickening and intramural diverticulosis. Though it has always been considered a hyperplastic benign disease, the possibility of malignant transformation is currently admitted. Through an analysis of their personal experience and of the relevant literature, the authors draw attention to anatomical and clinical features, diagnostic interpretations and up-to-date trends in the therapy of this condition. Over the period from 1990 to 2001, 13 patients with adenomyomatosis of the gallbladder were observed, amounting to 4% of all cholecystectomies performed over the same period. According to the extent of the disease three forms have been identified: diffuse (26%), segmental (26%) and localized (48%). The clinical presentation appears to be mainly conditioned by the frequent association with gallstones (84%), and for this reason ultrasonographic features were commonly interpreted as being signs of chronic inflammation or suspected neoplasia, though retrospective ultrasound evaluation revealed pathognomonic signs of gallbladder adenomyomatosis. Indications to surgery were therefore mainly based upon the presence of stones and chronic inflammation. Cholecystectomy is currently also indicated in symptomatic cases of non-lithiasic gallbladder adenomyomatosis, whereas there appears to be no such clear-cut rule for the treatment of asymptomatic cases. Nevertheless, prophylactic laparoscopic cholecystectomy may be justified considering the evolution, the uncertain nature of the disease and the difficult differential diagnosis versus malignant lesions