Gallbladder adenomas are uncommon gallbladder polyps that, although benign, have a premalignant behavior.
As the distinction of adenomas and intracholecystic papillary-tubular neoplasms (ICPN) is not entirely clear, with important overlap between both entities, some authors have proposed that all the adenomas over 1 cm should be grouped under the ICPN terminology 1,4. A note is made that the last WHO classification is from 2010, therefore, proceeding these publications.
Adenomas make 4% to 7% of all gallbladder polyps 1,3. They are incidentally found in about 0.5% of the gallbladder specimens 2.
There is a 2.4:1 female-to-male prevalence ratio 2.
Increased prevalence of gallbladder and biliary tract adenomas occurs in 1-3:
They are polypoid structures projecting into the gallbladder lumen usually measuring less than 2 cm in size, and showing either a sessile or pedunculated appearance. In about 10% of the cases, adenomas are multiple 2.
Gallbladder adenomas are classified in 2:
- tubular adenomas
- the most common
- composed by pyloric-type glands: cuboidal or columnar cells containing vesicular or hyperchromatic nuclei and covered by biliary epithelium
- or by intestinal-type glands: with pseudostratified columnar epithelium covered by biliary epithelium
- papillary adenomas
- papillary structures lined by cuboidal or columnar cells
- tubulopapillary adenomas
- subtype characterized when both the tubular glands and the papillary formations each corresponds to more than 20% of the tumor
Adenomas are usually solitary gallbladder wall lesions that can have a sessile, pedunculated, or polypoid appearance.
- usually hypoechoic with no posterior acoustic shadowing
- variable size, usually between 5 mm to 20 mm 1
- may have a lobulated or cauliflowerlike contour 2
- in the pedunculated lesions, the stalk might be difficult to visualize and might require changes in the patient decubitus
- internal vascularity at color Doppler may be demonstrated 3
- focal gallbladder wall thickening adjacent to the polyp is a worrisome feature concerning for malignancy 2
- CEUS: enhancement is seen in the arterial phase 1
They might be distinguished as small hypodense intraluminal gallbladder lesions that demonstrate enhancement 3.
Treatment and prognosis
Gallbladder adenomas are usually managed surgically. Please refer to the parental article on gallbladder polyps for guidelines on when followup or surgery should be considered.
- 1. Argha Chatterjee, Camila Lopes Vendrami, Paul Nikolaidis, Pardeep K. Mittal, Andrew J. Bandy, Christine O. Menias, Nancy A. Hammond, Vahid Yaghmai, Guang-Yu Yang, Frank H. Miller. Uncommon Intraluminal Tumors of the Gallbladder and Biliary Tract: Spectrum of Imaging Appearances. (2019) RadioGraphics. 39 (2): 388-412. doi:10.1148/rg.2019180164 - Pubmed
- 2. Angela D. Levy, Linda A. Murakata, Robert M. Abbott, Charles A. Rohrmann, Jr. From the Archives of the AFIP. (2002) RadioGraphics. 22 (2): 387-413. doi:10.1148/radiographics.22.2.g02mr08387 - Pubmed
- 3. Vincent M. Mellnick, Christine O. Menias, Kumar Sandrasegaran, Amy K. Hara, Ania Z. Kielar, Elizabeth M. Brunt, Maria B. Majella Doyle, Nirvikar Dahiya, Khaled M. Elsayes. Polypoid Lesions of the Gallbladder: Disease Spectrum with Pathologic Correlation. (2015) RadioGraphics. 35 (2): 387-99. doi:10.1148/rg.352140095 - Pubmed
- 4. Adsay V, Jang KT, Roa JC, Dursun N, Ohike N, Bagci P, Basturk O, Bandyopadhyay S, Cheng JD, Sarmiento JM, Escalona OT, Goodman M, Kong SY, Terry P. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases. (2012) The American journal of surgical pathology. 36 (9): 1279-301. doi:10.1097/PAS.0b013e318262787c - Pubmed
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Gallbladder and biliary tract pathology
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- diffuse gallbladder wall thickening (differential)
- focal gallbladder wall thickening (differential)
- porcelain gallbladder
- gallbladder polyps
- gallbladder malignancy
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- bile ducts neoplasms