title: Stepwise approach and surgery for gallbladder adenomyomatosis: a mini-review.
abstract: BACKGROUND
  Gallbladder adenomyomatosis (GBA) is a hyperplastic disease affecting the wall of the gallbladder, with some typical features. It has historically been considered a benign condition, nevertheless recent reports highlighted a potential role of GBA in predisposing to malignancies of the gallbladder.
  
  
  METHODS
  We reviewed the literature concerning GBA from its identification until July 2012. Owing to the relative rarity of the disease, studies often are case reports or case series. Thus we herein report a summary of the key-points concerning diagnosis and treatment of GBA, easily applicable in everyday practice, rather than a systematic review. Also, results are integrated with our recent experience.
  
  
  RESULTS
  In our experience, we observed a trend toward an increase of GBA during the last years, probably due to enhanced ultrasonographic technical advancements and physician's expertise. GBA has distinctive imaging features. Several recent reports highlight the potential risk of cancer associated with GBA; however the disease is still classified as a benign condition. Although its correlation with malignancy has not been demonstrated, it is prudent to recommend cholecystectomy in some cases. However, in selected asymptomatic patients, a wait-and-see policy is a viable alternative. We propose an algorithm, based on GBA pathological pattern (diffuse, segmental, localized or fundal), suitable for decision-making.
  
  
  CONCLUSIONS
  In symptomatic patients and if the diagnosis is doubtful, cholecystectomy is mandatory. Postponing surgery is an option to be offered to asymptomatic patients with low-risk GBA pattern who adhere to scheduled follow-ups.
authors.affiliation: Unit of General and Geriatric Surgery, School of Medicine, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pellino
authors.forename: Guido
authors.initials: G
authors.lastname: Sciaudone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Candilio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Perna
authors.forename: Antonio
authors.initials: A
authors.lastname: Santoriello
authors.forename: Silvestro
authors.initials: S
authors.lastname: Canonico
authors.forename: Francesco
authors.initials: F
authors.lastname: Selvaggi
mesh_terms: D018194:Adenomyoma / Q000175:diagnosis / Q000601:surgery*; D000465:Algorithms; D058070:Asymptomatic Diseases; D002763:Cholecystectomy; D003661:Decision Support Techniques; D003952:Diagnostic Imaging / Q000379:methods; D018450:Disease Progression; D019160:Endosonography; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D006965:Hyperplasia; D018579:Patient Selection; D011237:Predictive Value of Tests; D016896:Treatment Outcome