A Report of 478 Cases of Gallbladder Adenomyomatosis from a Single Center

Introduction: Gallbladder adenomyomatosis (ADM) is a non-neoplastic, non-inflammatory disease. Herein, we retrospectively analyzed pathologically confirmed cases of 15 years in our center to investigate the diagnosis and treatment of ADM. Method: Data of patients who received cholecystectomy and were pathologically confirmed to have gallbladder adenomyomatosis were retrieved from the pathological database of Peking University Third Hospital from January 1, 2003 to December 31, 2017. The epidemiology, clinical manifestation, imaging examinations, surgical treatments and pathological features of these patients were analyzed retrospectively. Result: Of the 14,454 patients who underwent cholecystectomy, 478 were pathologically confirmed to have gallbladder adenomyomatosis, with a detection rate of 3.3%. There were 369 cases (77.2%) with symptoms, 279 cases (58.4%) with gallbladder stones, and 2 cases (0.4%) with common bile duct stones. The preoperative diagnostic rates of ultrasound, contrast-enhanced computed tomography(CT), magnetic resonance cholangiopancreatography(MRCP) or contrast-enhanced magnetic resonance imaging(MRI) were 25.4% (108/425), 40.6% (58/143) and 45.8%(148/323), respectively. The diagnostic rate of ultrasound combined contrast-enhanced CT, MRCP or contrast-enhanced MRI were 64.1% (50/78). Laparoscopic cholecystectomy (LC) was performed in 436 cases (91.2%), with 1 case of common bile duct exploration, 1 case of endoscopic sphincterotomy(EST) on common bile duct stone, and 1 case of hepatoduodenal ligament lymph node dissection. Open cholecystectomy was performed in 42 cases (8.8%). There were 58 cases (12.1%) with cholesterol polyps or cholesterol deposition, 12 cases (2.5%) with gallbladder adenoma, and 2 cases (0.4%) with gallbladder carcinoma. Pathologically, 287 cases were classified into fundal type (239 cases, 83.3%), segmental type (27 cases, 9.4%), and diffuse type (21 cases, 7.3%). Conclusion: Gallbladder adenomyomatosis is often accompanied with gallbladder stones. Ultrasound combined with contrast-enhanced CT, MRCP or contrast-enhanced MRI can improve the diagnostic rate. Currently LC is the main procedure for the treatment of adenomyomatosis of gallbladder.