An unusual association of diffuse adenomyomatosis with dysplastic adenoma in chronic calculous cholecystitis: case presentation.
BACKGROUND
Gallbladder adenomyomatosis is an epithelial proliferation and hypertrophy of the muscularis mucosae of the gallbladder. Rokitansky-Aschoff sinuses are a characteristic of this condition. The segmental adenomyomatosis has a higher risk of developing into gallbladder carcinoma, especially in the fundal region of elderly patients.We report the case of a patient affected by chronic calculous cholecystitis with diffuse adenomyomatosis associated with dysplastic adenoma.


METHODS
An 81-year-old woman presented at our hospital with a 1-year history of intermittent pain localized at the right upper abdominal quadrant, without diffusion to any other body part. On physical examination the abdomen was soft, not distended, and tender to palpation in the right upper quadrant. Murphy sign was negative. Laboratory tests were normal. The patient was scheduled for a laparoscopic cholecystectomy, and neither endoscopic ultrasonographic scan nor magnetic resonance imaging was performed. The operation, performed after obtaining informed consent, was uncomplicated and the intra-operative pathological examination showed no malignancy. The definitive pathological examination of the gallbladder showed: multiple stones of cholesterol origin; diffuse mucosal adenomyomatosis; and a 1.1 cm pedunculated mass localized at the fundus, whose surface was lumpy. This mass was diagnosed as an adenoma with multiple areas of severe dysplasia.


CONCLUSIONS
The adenoma of the gallbladder, together with the dysplasia, represents a biological carcinogenetic model. Carcinoma has rarely been reported in adenomyomatosis. Degenerative risk suggests surgery should be mandatory when there is a concomitant presence of large adenoma and adenomyomatosis.
Di Carlo
Isidoro
I
Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Catania, Italy. idicarlo@unict.it
Toro
Adriana
A
Pulvirenti
Elia
E
Zisa
Monica
M
Galia
Antonio
A
D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D018194:Adenomyoma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D000369:Aged, 80 and over; D049109:Cell Proliferation; D002764:Cholecystitis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D002908:Chronic Disease; D015897:Comorbidity; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D006984:Hypertrophy