Presentation
Right upper quadrant pain.
Patient Data
The fundus of the gallbladder is diffusely abnormal and characterized by thickening of the gallbladder wall with multiple cystic spaces identified within this segment of the gallbladder wall. Within some of the cystic spaces, there are echogenic foci some of which demonstrate posterior acoustic shadowing consistent with stones. Further echogenic foci which are punctate and show 'comet tail' artefact and are consistent with cholesterolosis. Within the neck of the gallbladder, there is a calculus which is non-mobile.
MRCP demonstrates an abnormality of the body and fundus of the gallbladder characterized by multiple cystic spaces within a thickened gallbladder wall. Some of these cystic spaces demonstrate low signal foci on the T2 weighted imaging in keeping with calculi. There are low signal foci within the fundus of the gallbladder also in keeping with a dependent gallbladder calculus. There is a calculus within the neck of the gallbladder measuring approximately 8 mm. No fluid surrounding the gallbladder. No intra or extrahepatic biliary tree dilatation.
Case Discussion
This case shows abnormalities of the gallbladder in keeping with adenomyomatosis. The patient was submitted to cholecystectomy.
MACROSCOPIC DESCRIPTION: "Gallbladder": An intact gallbladder measuring 110x35mm. The cystic duct is 3x3mm. The serosa appears diffusely congested. The maximum thickness of gallbladder wall is 13mm. The mucosa wall is diffusely congested and indurated. There is a focal area of nodularity spanning 20mm and is approximately 50mm from the cystic duct margin. The gallbladder lumen has two gallstones, each measuring 10mm.
MICROSCOPIC DESCRIPTION: Sections of the gallbladder wall show patchy mucosal ulceration. The intact areas show mucosal lining, which shows mild reactive atypia. The gallbladder wall is thickened, hemorrhagic, edematous and acutely inflamed. Occasional Rokitansky Aschoff sinuses are seen. Reactive peribiliary glands are present. There is no evidence of dysplasia or invasive malignancy.
DIAGNOSIS: Gallbladder: Acute on chronic cholecystitis; adenomyomata. No evidence of dysplasia or invasive malignancy identified.
Case courtesy of Dr Beng Ghee Lim and The Royal Melbourne Hospital Pathology department.