Lee Kit-Fai, Hung Esther H Y, Leung Howard H W, Lai Paul B S
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China.
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China.
Ann Transl Med. 2020 Dec;8(23):1600. doi: 10.21037/atm-20-4897.
Gallbladder adenomyomatosis (GA) is increasingly encountered in clinical practice due to increasing use of imagings especially ultrasound (US). Clinicians need to know what is the implication of this condition and its proper management. GA is a degenerative and proliferative disease characterized by excessive epithelial proliferation associated with hypertrophy of muscularis propria. This leads to outpouchings of mucosa into or beyond the muscle layer forming intramural diverticula recognized as Rokitansky-Aschoff sinuses (RAS). Three types of GA are recognised: fundal, segmental and diffuse type. In fundal GA, there is focal thickening involving the GB fundus. In segmental GA, there is circumferential overgrowth of the GB wall that leads to formation of compartments. In diffuse GA, there is disseminated thickening and irregularity of the mucosa and muscularis. The pathogenesis of GA is unknown. It commonly occurs in middle age with equal sex distribution. Diagnosis of GA is by imagings showing thickened gallbladder wall containing cysts. Characteristic features are "comet-tail" artefacts and "twinkling" artefacts on US, "pearl-necklace sign" on magnetic resonance imaging (MRI) and "rosary sign" on computed tomography (CT). Cholecystectomy should be offered for symptomatic GA of any type. For asymptomatic GA, cholecystectomy may be considered for segmental type for its increased risk of malignancy and for diffuse type for its difficult visualization of any coexisting malignancy. Asymptomatic fundal GA can be safely observed with US. How frequent and how long should a fundal GA be monitored with US remains unknown. In case of diagnostic doubt, cholecystectomy should always be offered to avoid overlooked malignancy.
由于影像学检查尤其是超声（US）的使用增加，胆囊腺肌增生症（GA）在临床实践中越来越常见。临床医生需要了解这种情况的意义及其正确的管理方法。GA是一种退行性和增殖性疾病，其特征是上皮过度增殖并伴有固有肌层肥大。这导致黏膜向肌层内或肌层外突出，形成壁内憩室，即罗-阿窦（RAS）。GA可分为三种类型：基底型、节段型和弥漫型。在基底型GA中，胆囊底部有局灶性增厚。在节段型GA中，胆囊壁周向增生，导致形成间隔。在弥漫型GA中，黏膜和肌层有弥漫性增厚和不规则。GA的发病机制尚不清楚。它常见于中年，男女发病率相等。GA的诊断依靠影像学检查显示胆囊壁增厚并含有囊肿。特征性表现为超声上的“彗尾”伪像和“闪烁”伪像、磁共振成像（MRI）上的“珍珠项链征”以及计算机断层扫描（CT）上的“念珠征”。对于任何类型的有症状GA，均应行胆囊切除术。对于无症状GA，节段型因其恶性风险增加、弥漫型因其难以发现并存的恶性肿瘤，可考虑行胆囊切除术。无症状的基底型GA可通过超声安全观察。基底型GA应通过超声监测多久以及监测频率如何仍不清楚。如果诊断存疑，应始终提供胆囊切除术以避免遗漏恶性肿瘤。
