THE CHALLENGES OF DIFFERENTIAL DIAGNOSIS IN ADENOMYOMATOSIS - A CASE REPORT
Gallbladder adenomyomatosis (GAM) is a type of hyperplastic cholecystopathy, characterized by benign gallbladder thickening, determined by excessive proliferation of the surface epithelium into a thickened muscularis propria. It is an incidental finding in approximately 9% of cholecystectomies, GAM being an asymptomatic entity. Its prevalence rises with age, while having a female predilection. From all forms of GAM (focal, segmental and diffuse), the segmental form is considered the most difficult to distinguish from gallbladder carcinoma. D.L., a 44-year-old male was admitted for further investigations and treatment of a suspected gallbladder malignancy. The patient reported right hypochondrium colicative pain and nausea. An abdominal ultrasound performed prior to his admission, had shown a gallbladder with irregular thickened wall, without lithiasis. Clinical examination revealed pain in the right hypochondriac region, no peritoneal irritation and negative Murphy maneuver. Abdominal ultrasound revealed numerous small hyperechoic images , segmental mural thickening with double-contour and discontinuity of the wall and uneven caliber of the common bile duct. Abdominal computed tomography showed rosary sign (a suggestive aspect of GAM). The therapeutic approach consisted in laparoscopic cholecystectomy,. On gross evaluation, the gallbladder had lithiasic aspect and a thickened wall. The pathological examination revealed adenomyomatosis of the gallbladder, chronic cholecystitis and microlithiasis. The patient’s evolution was uneventful. In conclusion, we present a case of GAM in a 44-year-old male. The particularity of this report consists in the initial diagnosis of cancer and the low rate of incidence of the disease (9% of cholecystectomy specimens). Furthermore, the age and gender of the patient are not characteristic for this illness.