Gallbladder & extrahepatic bile ducts
Gallbladder nonneoplastic
Adenomyomatous hyperplasia


Topic Completed: 15 April 2021

Minor changes: 15 April 2021

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PubMed Search: Adenomyomatous hyperplasia gallbladder

Alan A. George, D.O.
Monica T. Garcia-Buitrago, M.D.
Page views in 2020: 13,894
Page views in 2021 to date: 6,106
Cite this page: George AA, Garcia-Buitrago MT. Adenomyomatous hyperplasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/gallbladderadenomyomatous.html. Accessed April 15th, 2021.
Definition / general
Essential features
Terminology
  • Also called adenomyoma, adenomyomatosis (Korean J Gastroenterol 2016;67:332)
  • Generalized, segmental or localized types
    • Generalized:
      • Diffuse wall thickening (up to 5x normal) with intramural diverticula resembling cystic spaces within the wall
      • Also called adenomyomatosis, adenomyosis
    • Localized:
      • Fundus has nodules from 0.5 to 2.5 cm with grayish white cut surface containing multiple cysts
      • May cause gallbladder inversion
      • Also called adenomyoma
Epidemiology
Sites
  • Gallbladder (fundus if localized), rarely extrahepatic bile ducts
Pathophysiology
Diagnosis
  • Usually diagnosed by microscopic evaluation of hematoxylin and eosin stained slides
Radiology description
Radiology images

Images hosted on other servers:

Ultrasound images of gallbladder adenomyoma

Case reports
Gross images

Contributed by Alan A. George, D.O. and Monica T. Garcia-Buitrago, M.D.

Localized adenomyoma



Images hosted on other servers:

Diffuse adenomyomatous hyperplasia

Adenomyomatosis

Focal adenomyoma

Microscopic (histologic) description
  • Cystically dilated benign biliary glands accompanied by smooth muscle hypertrophy of gallbladder wall, thickened / fibrotic subserosa (StatPearls: Adenomyomatosis [Accessed 26 January 2021])
  • Glands are distinct from the Rokitansky-Aschoff sinuses, which are epithelial diverticula, usually multifocal and occur throughout gallbladder secondary to injury, versus adenomyomatous nodule (distinct localized lesion of the gallbladder wall, 1 - 1.5 cm mural nodule in the fundus) (Am J Surg Pathol 2020;44:1649)
  • May have reactive epithelial changes, papillary change and intestinal metaplasia (StatPearls: Adenomyomatosis [Accessed 26 January 2021])
  • Rarely, benign glands are seen in proximity to nerves, appearing as 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)
  • Adenomyomatous nodules may rarely show dysplastic / carcinomatous transformation, whereas dysplasia in Rokitansky-Aschoff sinuses appears to be more common; however, the true association between adenomyomatous nodules and neoplasia has not yet been determined (Am J Surg Pathol 2020;44:1649)
  • Recently, papillary dysplastic lesions of adenomyomas have been identified (intracholecystic neoplasms of adenomyomas), demonstrating cystic and solid areas with papillary projections that show biliary, gastric and intestinal phenotypes, with low or high grade dysplasia (Am J Surg Pathol 2020;44:1649)
  • In general, biliary dysplasia (biliary intraepithelial neoplasia [BilIN]) can be either low grade or high grade and is recognized by the abrupt transition from normal mucosa with nuclear hyperchromasia, overlapping and enlargement in low grade, with the inclusion of those features as well as loss of nuclear polarity/nuclear stratification seen in high grade dysplasia
Microscopic (histologic) images

Contributed by Monica T. Garcia-Buitrago, M.D.

Cystically dilated biliary glands

Adenomyomatous hyperplasia / adenomyomatous nodule

Dilated biliary gland, surrounding smooth muscle


Smooth muscle hyperplasia surrounding biliary glands

Thickened smooth muscle surrounding biliary gland

Cystically dilated biliary glands, adjacent nerve

Smooth muscle surrounding cystically dilated biliary glands

Sample pathology report
  • Gallbladder, cholecystectomy:
    • Chronic cholecystitis and cholelithiasis with adenomyomatous hyperplasia
Differential diagnosis
  • Adenocarcinoma:
    • Glands and tubules lined by cuboidal to columnar epithelium
    • Cytologic atypia
    • Prominent nucleoli
    • Increased mitotic activity
    • Desmoplastic stroma
  • Chronic cholecystitis:
    • Lymphoplasmacytic infiltrates in lamina propria, may extend deeper, occasionally form lymphoid aggregates / follicles, occasionally may contain eosinophils
    • May contain Rokitansky-Aschoff sinuses: epithelial diverticula that can occur throughout gallbladder secondary to injury
    • Thickened wall with mural fibrosis
    • May have smooth muscle hyperplasia
Board review style question #1

The above lesion is found in the gallbladder of a 60 year old woman with gallstones. What is the diagnosis?

  1. Acute cholecystitis
  2. Adenomyomatous hyperplasia
  3. Biliary intraepithelial neoplasia
  4. Follicular cholecystitis
  5. Well differentiated adenocarcinoma
Board review style answer #1
B. Adenomyomatous hyperplasia

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Reference: Adenomyomatous hyperplasia
Board review style question #2
Which of the following is most commonly associated with adenomyomatous hyperplasia of the gallbladder?

  1. Acute cholecystitis
  2. Biliary intraepithelial neoplasia
  3. Chronic biliary epithelial inflammation / injury (chronic cholecystitis, cholelithiasis)
  4. Invasive adenocarcinoma
  5. Involvement of extrahepatic bile ducts
Board review style answer #2
C. Chronic biliary epithelial inflammation / injury (chronic cholecystitis, cholelithiasis)

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Reference: Adenomyomatous hyperplasia
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