Adenomyomatosis of the gallbladder (histology)

Case contributed by Dr Andrew Ryan

Presentation

RUQ pain with gallstones on U/S

Patient Data

Age: 70 years
Gender: Female

Histology of gallbladder following routine cholecystectomy:

Low power of gallbladder wall (with mucosa facing left and serosa right). 
The muscle wall is thickened with multiple prolapsed glands in the subserosal tissue (Rokitansky-Aschoff sinuses); the glands are variably dilated, including one containing fragmented 'orange/brown' material (inspissated bile).

Medium power - One of the glands contains inspissated bile, in areas starting to form aggregated clumps.

Medium power of gallbladder wall (mucosa top left). The angular, mildly dilated glands (Rokitansky-Aschoff sinuses) prolapse between muscle bundles, with presumed residual communication with the overlying mucosa, akin to colonic diverticula.

Case Discussion

This is a case of adenomyomatous hyperplasia of the gallbladder, which is just another name for a localized, mass-forming collection of Rokitansky-Aschoff sinuses. It is commonly seen at the gallbladder fundus and is akin to colonic diverticula.

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