Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Catania, Italy.
BMC Gastroenterol. 2010 Apr 27;10:41. doi: 10.1186/1471-230X-10-41.
Gallbladder adenomyomatosis is an epithelial proliferation and hypertrophy of the muscularis mucosae of the gallbladder. Rokitansky-Aschoff sinuses are a characteristic of this condition. The segmental adenomyomatosis has a higher risk of developing into gallbladder carcinoma, especially in the fundal region of elderly patients.We report the case of a patient affected by chronic calculous cholecystitis with diffuse adenomyomatosis associated with dysplastic adenoma.
An 81-year-old woman presented at our hospital with a 1-year history of intermittent pain localized at the right upper abdominal quadrant, without diffusion to any other body part. On physical examination the abdomen was soft, not distended, and tender to palpation in the right upper quadrant. Murphy sign was negative. Laboratory tests were normal. The patient was scheduled for a laparoscopic cholecystectomy, and neither endoscopic ultrasonographic scan nor magnetic resonance imaging was performed. The operation, performed after obtaining informed consent, was uncomplicated and the intra-operative pathological examination showed no malignancy. The definitive pathological examination of the gallbladder showed: multiple stones of cholesterol origin; diffuse mucosal adenomyomatosis; and a 1.1 cm pedunculated mass localized at the fundus, whose surface was lumpy. This mass was diagnosed as an adenoma with multiple areas of severe dysplasia.
The adenoma of the gallbladder, together with the dysplasia, represents a biological carcinogenetic model. Carcinoma has rarely been reported in adenomyomatosis. Degenerative risk suggests surgery should be mandatory when there is a concomitant presence of large adenoma and adenomyomatosis.
胆囊腺肌症是胆囊黏膜上皮和固有肌层的增生和肥大。罗基坦斯基-阿绍夫窦是其特征性表现。节段性腺肌症发生胆囊癌的风险较高，尤其是老年患者的胆囊底部。我们报告了一例患有慢性结石性胆囊炎的患者，其胆囊弥漫性腺肌症伴异型增生性腺瘤。
一名 81 岁女性因右上腹间歇性疼痛 1 年来我院就诊，疼痛无向其他部位扩散。体格检查发现腹部柔软，无膨隆，右上腹触诊有压痛。墨菲征阴性。实验室检查正常。患者接受了腹腔镜胆囊切除术，术前未行超声内镜或磁共振成像检查。在获得知情同意后进行了手术，手术过程顺利，术中病理检查未见恶性肿瘤。胆囊的最终病理检查显示：多发性胆固醇结石；弥漫性黏膜腺肌症；胆囊底部有 1.1 厘米带蒂的肿块，表面凹凸不平。该肿块被诊断为多发性重度异型增生的腺瘤。
胆囊腺瘤伴异型增生代表了一种生物学致癌模型。腺肌症中很少报道有癌。当存在大腺瘤和腺肌症时，建议手术切除以降低恶变风险。
