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Gallbladder

Miscellaneous non-tumor

Adenomyomatous hyperplasia

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 13 February 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Also called adenomyomatosis, diverticular disease of gallbladder
● Benign
● Usually asymptomatic
● Relatively common (9% of cholecystectomy specimens)
● 80% associated with chronic cholecystitis
● Rarely associated with dysplasia and carcinoma

Terminology
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● Generalized, segmental or localized types

Generalized:
● Diffuse wall thickening (up to 5x normal) with intramural diverticula resembling cystic spaces within the wall

Segmental:
● Focal thickening in gallbladder wall, usually body, giving it an hourglass configuration

Localized:
● Fundus has nodules from 0.5 to 2.5 cm with gray-white cut surface containing multiple cysts
● May cause gallbladder inversion
● Also called adenomyoma

Case reports
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● 34 year old woman with polypoid leiomyosarcoma (Ann Diagn Pathol 2004;8:358)
● Three cases with fundal variant (J Clin Med Res 2010;2:150)

Gross images
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Various images

Micro description
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● Two types: (a) numerous Rokitansky-Aschoff sinuses accompanied by smooth muscle hyperplasia and expanded subserosal layer containing numerous nerve trunks; (b) extensively fibrotic gallbladder wall with numerous Rokitansky-Aschoff sinuses but few/no smooth muscle bundles and an expanded subserosal layer containing abundant nerve-trunks; surface epithelium may be papillary
● May have reactive epithelial changes and metaplasia
● Rarely has perineural and intraneural invasion only in the subserosal layer (benign gland-like structures may migrate into nerves due to chemotactic factors or signaling substances with activation of cell receptors, Am J Surg Pathol 2007;31:1598)

Micro images
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Various images

Differential diagnosis
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● Adenocarcinoma or “adenoma malignum”
● Chronic cholecystitis

End of Gallbladder > Miscellaneous non-tumor > Adenomyomatous hyperplasia

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