What is Adenomyomatosis?
Adenomyomatosis, also known as adenomyoma, is a non-harmful condition that affects the gallbladder. It is one of two types of what’s known as hyperplastic cholecystoses – the other one being cholesterolosis, otherwise known as “strawberry gallbladder.” Adenomyomatosis involves the gallbladder’s wall becoming thicker and developing pockets called Rokitansky-Aschoff sinuses. Stones or cholesterol crystals can sometimes be found within these pockets, which are key indicators of Adenomyomatosis when looking at medical images.
However, this condition can sometimes be difficult to distinguish from gallbladder cancer, especially if the typical image findings are not present. Adenomyomatosis usually doesn’t show any symptoms and can be discovered by accident during unrelated health checks. Therefore, it often doesn’t require specific treatment. However, in some cases, Adenomyomatosis can cause pain in the upper right side of your abdomen. If the pain persists, or if there’s difficulty in diagnosing whether it’s Adenomyomatosis or gallbladder cancer, your doctor might advise removing the gallbladder through a procedure known as cholecystectomy.
What Causes Adenomyomatosis?
The exact cause of adenomyomatosis, a condition of the gallbladder, is still unknown. However, some believe it could be a reaction to long-term inflammation in the gallbladder. Since most diagnoses occur in people in their 50s, this hypothesis has some credibility.
Initially, adenomyomatosis was seen as a potentially cancerous change in the gallbladder. But nowadays, most research considers it to be a harmless change that is often linked to cholecystitis (inflammation of the gallbladder) and cholecystolithiasis (gallstones).
Gallbladder cancer, however, is a highly aggressive disease. People diagnosed with this type of cancer, unfortunately, have less than a 5 percent chance of living beyond five years.
Risk Factors and Frequency for Adenomyomatosis
Adenomyomatosis is a condition that is often found in 1 to 8.7 percent of gallbladder surgery samples. People diagnosed with this ailment can range in age, but it is usually found in those in their 50s. There is some disagreement in medical writings about whether adenomyomatosis affects more men or women. Some sources proclaim it to be more common in women by a ratio of 3 to 1, whilst others argue that men and women have a similar likelihood of the condition. It’s important to note that adenomyomatosis doesn’t favor any particular ethnic or racial group.
Signs and Symptoms of Adenomyomatosis
Adenomyomatosis is a condition affecting the gallbladder, and many people with it do not experience any symptoms. However, some people may experience pain in the upper right quadrant of their abdomen. In some cases, alongside adenomyomatosis, patients might also have gallstones, which can be symptomatic and cause discomfort.
Testing for Adenomyomatosis
If you experience pain in the upper right area of your abdomen, it’s recommended to first use an ultrasound examination to determine the cause. This examination can identify signs of a medical condition called adenomyomatosis, which affects the gallbladder.
The ultrasound might reveal thickening of the gallbladder wall, a common sign of this condition. However, sometimes the ultrasound findings aren’t conclusive. If that happens, we may use magnetic resonance imaging (MRI) for a more detailed examination of your abdomen.
When the wall thickening is noted by chance during a computed tomography (CT) scan, further diagnostics with an ultrasound or MRI might also be necessary. Adenomyomatosis is characterized by gallbladder wall thickening, as well as Rokitansky-Aschoff sinuses and small stones or cholesterol crystals often found in the sinuses.
During an ultrasound, adenomyomatosis might appear as thickening of the gallbladder wall, small fluid-filled spaces within the wall, and bright spots (caused by cholesterol crystals) that create a “comet tail” pattern. However, it’s worth noting that not all these signs are always present.
The bright spots creating a “comet tail” pattern are considered a specific sign for adenomyomatosis. When using MRI, adenomyomatosis might appear as thickening of the gallbladder wall, fluid-filled spaces inside the wall that appear very bright on MRI, and small stones that appear as dark spots. These fluid-filled spaces can appear in a curvilinear pattern, creating a “pearl necklace sign.”
During a CT scan exam, nonspecific gallbladder wall thickening and wall’s unique enhancement might be noticed. There can be a “rosary sign” – when the wall of the gallbladder resembles a rosary, due to the lining of the small pouches within the wall which are surrounded by less-enhancing thickened muscle wall.
Treatment Options for Adenomyomatosis
If a patient presents with a condition called adenomyomatosis, and the doctors find it challenging to differentiate it from gallbladder cancer, or if the adenomyomatosis is causing pain in the upper right side of the abdomen, then the treatment usually involves a surgery called cholecystectomy. This is the surgical removal of the gallbladder. However, if adenomyomatosis is found unexpectedly during a test or a procedure and the patient has no related symptoms, the doctors usually do not recommend any treatment.
What else can Adenomyomatosis be?
When a doctor is trying to diagnose adenomyomatosis of the gallbladder, there are a number of other conditions they need to consider. These include:
- Cancers of the gallbladder, such as adenocarcinoma or cholangiocarcinoma
- Metastatic disease, which is a kind of cancer that has spread from its original location
- Gallbladder polyps, which are growths that form on the surface of the gallbladder
- Benign (non-cancerous) tumors of the gallbladder, such as adenoma
It’s also possible for the gallbladder to look different in some people, with folds known as a “Phrygian cap”. This is normal and doesn’t mean there’s an illness or condition.
What to expect with Adenomyomatosis
Some patients experience pain in the upper right section of their abdomen due to a condition that is generally harmless and has a good outlook. It’s crucial to mention that not everyone shows symptoms. There’s a condition named adenomyomatosis that typically doesn’t cause symptoms and is often discovered unintentionally during other medical examinations.
It should be noted that gallbladder cancer can have a similar look to adenomyomatosis on medical images, but the prognosis for gallbladder cancer is much worse in comparison. Therefore, it’s crucial to have certainty in the diagnosis of adenomyomatosis from imaging results before ruling out any abnormalities.
Possible Complications When Diagnosed with Adenomyomatosis
Adenomyomatosis is not proven to directly cause cancer, but it may lead to inflammatory complications.
Preventing Adenomyomatosis
Educating patients is essential for effectively managing those who experience pain in the upper right part of their abdomen. Nurses play an important role in this process, working closely with doctors and other healthcare providers to teach patients about adenomyomatosis of the gallbladder – a disease that affects the gallbladder. It’s vital that nurses urge patients to immediately tell their healthcare providers if their symptoms worsen. Additionally, patients should receive written pamphlets with information about gallbladder adenomyomatosis to further aid their understanding and management of the condition.
