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Adenoma and adenomyomatosis of the gallbladder
Last reviewed: 05.07.2025
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Adenomas and adenomyomatosis of the gallbladder (GB) are rare diseases and until recently were most often incidental surgical findings. Adenomas (occur in less than 1% of cases) are benign formations of the GB, represented by multiple or single glandular or papillary growths. In typical cases, they are represented by polypoid solitary formations from 0.5 to 2 cm in diameter, the so-called polyps.
[ Causes of gallbladder adenomyomatosis
Adenomyomatosis of the gallbladder (frequency 1-3%) is also classified as a benign GB lesion (group of hyperplastic cholecystoses), which is characterized by proliferative and degenerative changes in the organ wall with the formation of intramural cystic cavities and deep crypts in most cases. The most characteristic changes are considered to be deepening and branching of the Rokitansky-Aschoff sinuses, hyperplasia of the muscular layer, while the epithelium sometimes undergoes intestinal metaplasia. The etiology and pathogenesis of the disease have not been sufficiently studied, but in 40-60% of cases, a combination with cholelithiasis and chronic cholecystitis is noted. It is 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 gallbladder. Ultrasound is used in the diagnosis of diseases. Ultrasound reveals thickening of the gallbladder wall up to 6-8 mm or more, adenomyomatosis, polypoid immobile echostructures protruding into the lumen of the gallbladder and not giving an ultrasound shadow (adenomas). When using oral cholecystography (used in previous years) and filling diverticulum-like intramural formations of the gallbladder with a contrast agent (dilated Rokitansky-Aschoff sinuses in adenomyomatosis), small rounded filling defects can be determined, characteristic of adenomas protruding into the lumen of the gallbladder.
In recent years, MRI (including MRCP) has been increasingly used in diagnostics.
Treatment of gallbladder adenomyomatosis
Small (less than 1 cm) multiple (3 or more) gallbladder adenomas have virtually no risk of malignancy, so indications for surgery are largely determined based on the severity of clinical manifestations. At the same time, many specialists classify single adenomas measuring 10-15 mm or more as precancerous diseases (the detection rate of gallbladder cancer during histological examination of the removed gallbladder reaches 20%). In this regard, such patients are indicated for planned cholecystectomy with urgent histological examination (in case of gallbladder cancer - extended cholecystectomy).
In case of adenomyomatosis manifested by clinical symptoms and confirmed by the results of instrumental examination methods, cholecystectomy is indicated. Asymptomatic adenomyomatosis of the gallbladder does not require special treatment.