Wen Li-Jia, Chen Jun-Hong, Chen Yong-Jin, Liu Kai
Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China.
World J Clin Cases. 2020 Jan 26;8(2):464-470. doi: 10.12998/wjcc.v8.i2.464.
Gallbladder adenomyomatosis (GAM) is a benign lesion, characterized by thickening of the gallbladder wall and a focal mass, which overlap with the features of gallbladder malignancy. Consequently, differential diagnosis of GAM from gallbladder cancer is difficult and approximately 20% of suspected malignant biliary strictures are postoperatively confirmed as benign lesions. Herein, we report a case in which a preoperative diagnosis of GAM was made by a combination of endoscopic and imaging techniques.
A 40-year-old man was referred to our hospital chiefly for a fever and right upper abdominal pain with dark urine. Enhanced computed tomography showed thickening of the gallbladder wall and a mass in the gallbladder neck with involvement of the hepatic bile ducts, which was suspected to be malignant. Gallbladder malignancy with bile duct invasion was ruled out by subsequent endoscopic examinations, including endoscopic retrograde cholangio-pancreatography, intraductal ultrasound, and SpyGlass. Endoscopic examinations showed a homogeneous hyperechoic lesion with smooth margins of benign bile duct stricture suggestive of inflammatory stenosis of the bile duct. The patient underwent laparoscopic cholecystectomy. GAM was postoperatively diagnosed and confirmed based on the histopathology results, which are consistent with the preoperative diagnosis. Notably, no malignant event occurred in the patient during a 12-mo follow-up period.
A combination of endoscopic techniques may help in the differential diagnosis of GAM from gallbladder cancer.
胆囊腺肌症（GAM）是一种良性病变，其特征为胆囊壁增厚和局灶性肿块，这些特征与胆囊恶性肿瘤有重叠。因此，胆囊腺肌症与胆囊癌的鉴别诊断较为困难，约20%疑似恶性胆管狭窄术后被证实为良性病变。在此，我们报告一例通过内镜和影像学技术联合进行术前诊断为胆囊腺肌症的病例。
一名40岁男性因发热、右上腹疼痛伴深色尿被转诊至我院。增强计算机断层扫描显示胆囊壁增厚，胆囊颈部有一肿块，累及肝内胆管，怀疑为恶性。随后的内镜检查，包括内镜逆行胰胆管造影、导管内超声和SpyGlass，排除了伴有胆管侵犯的胆囊恶性肿瘤。内镜检查显示一个边界光滑的均匀高回声病变，提示良性胆管狭窄为炎性狭窄。患者接受了腹腔镜胆囊切除术。术后根据组织病理学结果诊断并确诊为胆囊腺肌症，与术前诊断一致。值得注意的是，在12个月的随访期内患者未发生恶性事件。
内镜技术联合应用可能有助于胆囊腺肌症与胆囊癌的鉴别诊断。
