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Adenomy and adenomyomatosis of the gallbladder
Last reviewed: 23.04.2024
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Adenomas and adenomyomatosis of the gallbladder (GI) are rare diseases and until recently were most often accidental operational findings. Adenomas (found in less than 1% of cases) are referred to benign formations of HP, represented by multiple or single glandular or papillary growths. Typical cases are represented by polypoid solitary formations from 0.5 to 2 cm in diameter; polyps.
[Causes of gallbladder adenomyomatosis
Adenomyomatosis of the gallbladder (frequency 1-3%) is also attributed to benign lesions of the HP (group of hyperplastic cholecystoses), which are characterized by proliferative and degenerative changes in the organ wall with the formation in most cases of intra-wall cystic cavities and deep crypts. The most characteristic changes are the deepening and branching of the Rokitansky-Ashot sines, the hyperplasia of the muscular layer, while the epithelium is sometimes subjected to intestinal metaplasia. The etiology and pathogenesis of the disease have not been adequately studied, but in 40-60% of cases there is a combination with cholelithiasis, chronic cholecystitis. More common in women.
Diagnosis of gallbladder adenomyomatosis
Adenomas and adenomyomatosis of the gallbladder are most often not diagnosed before surgery or before a thorough examination of the HP. In the diagnosis of diseases using ultrasound. When ultrasound is detected thickening of the wall of the HP to 6-8 mm or more, adenomyomatosis, polypoid immobile echostructure, protruding into the lumen of the HP and not giving an ultrasonic shade (adenomas). With the use of oral cholecystography (used in previous years) and the filling of the diverticuloidal intra-wall formations of the rectum (widened sinuses of Rokitansky-Aschoff with adenomyomatosis) with a contrast agent, small rounded filling defects typical for the adenomas protruding into the lumen of the HP can be determined.
In recent years, MRI has been increasingly used in diagnosis (including MRCP).
Treatment of gallbladder adenomyomatosis
Small (less than 1 cm) multiple (3 or more) adenomas of the gallbladder practically have no risk of malignancy, therefore indications for surgery are determined to a greater extent on the basis of the severity of clinical manifestations. At the same time, many specialists refer to single adenomas with dimensions of 10-15 mm or more to precancerous diseases (the incidence of detection of HPV during histological examination of remote HP reaches 20%). In this connection, such a patient shows planned cholecystectomy with urgent histological examination (in case of cancer of the GP - enlarged cholecystectomy).
In the case of adenomyomatosis, manifested by clinical symptoms and confirmed by the results of instrumental research methods, cholecystectomy is indicated. Asymptomatic adenomyomatosis of the gallbladder does not require special treatment.