Medicine:Adenomyomatosis
| Adenomyomatosis | |
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| Micrograph showing Rokitansky–Aschoff sinus. H&E stain. |
Adenomyomatosis is a benign condition characterized by hyperplastic changes of unknown cause involving the wall of the gallbladder.[1] Adenomyomatosis is caused by an overgrowth of the mucosa, thickening of the muscular wall, and formation of intramural diverticula or sinus tracts termed Rokitansky–Aschoff sinuses, also called entrapped epithelial crypts.[citation needed]
Signs and symptoms
Pathophysiology
File:UOTW 79 - Ultrasound of the Week 1.webm
a The fundus of the gallbladder wall was thickened and the GB wall was obscure.
b The intramural echogenic foci were detected by high frequency transducer.
c CEUS—arterial phase (22 s) —heterogeneous hyper-enhancement and wall was intact.
d CEUS—venous phase (34 s) the anechoic spaces were more clear.
Rokitansky–Aschoff sinuses
Rokitansky–Aschoff sinuses are pseudodiverticula or pockets in the wall of the gallbladder. They may be microscopic or macroscopic. Histologically, they are outpouchings of gallbladder mucosa into the gallbladder muscle layer and subserosal tissue as a result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall.[4]
Rokitansky–Aschoff sinuses are not of themselves considered abnormal but they can be associated with cholecystitis.[5]
They form as a result of increased pressure in the gallbladder and recurrent damage to the wall of the gallbladder.[6]
Associations
Black pigment gallstones can form in Rokitansky–Aschoff sinuses of the gallbladder after the fourth to fifth decades of life in absence of the typical risk factors for bilirubin supersaturation of bile.[4] Hence, they are associated with gallstones (cholelithiasis). Cases of gall bladder cancer have also been reported to arise from Rokitansky–Aschoff sinuses.[7]
Diagnosis
Abdominal ultrasound has low accuracy in differentiating gall bladder adenomyomatosis from cancer and is operator dependent. However, it is used as the exam of the first-line due to its wide availability. Ultrasound findings may show thickened gall bladder wall, tiny anechoic spaces (Rokitansky–Aschoff sinuses or RAS), and twinkling artifact (or comet-tail reverberation). Comet tail reverberation, which is due to reflections from cholesterol crystals, is a highly specific sign for adenomyomatosis.[8]
On CT scan, it may show rosary sign, showing mucosal epithelium with intramural diverticula.[8]
Magnetic resonance imaging also plays an important role in the diagnosis of Rokitansky–Aschoff sinuses.[9] In fat-suppression MRI, RAS present with small, rounded, high signal intensity foci, called “pearl necklace sign”.[8]
Eponym
Rokitansky–Aschoff sinuses are named after Carl Freiherr von Rokitansky (1804–1878), a pathologist in Vienna, Austria and Ludwig Aschoff (1866–1942), a pathologist in Bonn, Germany.[10][11]
See also
- Cholecystectomy
- Strawberry gallbladder
- Diverticulum
- Hyperplasia
- Gallbladder
References
- ↑ "Adenomyomatosis of the gallbladder". Surgery 78 (2): 224–9. August 1975. PMID 1154265.
- ↑ "UOTW#79 - Ultrasound of the Week". 16 April 2017. https://www.ultrasoundoftheweek.com/uotw-79/.
- ↑ "Contrast-enhanced ultrasonography diagnosis of fundal localized type of gallbladder adenomyomatosis". BMC Gastroenterology 15 (1): 99. August 2015. doi:10.1186/s12876-015-0326-y. PMID 26239485.
- ↑ 4.0 4.1 "Rokitansky-Aschoff sinuses of the gallbladder are associated with black pigment gallstone formation: a scanning electron microscopy study". Ultrastructural Pathology 27 (4): 265–70. 2002. doi:10.1080/01913120309913. PMID 12907372.
- ↑ "Diffuse gallbladder wall thickening: differential diagnosis". AJR. American Journal of Roentgenology 188 (2): 495–501. February 2007. doi:10.2214/AJR.05.1712. PMID 17242260.
- ↑ "Imaging of adenomyomatosis of the gall bladder". Journal of Medical Imaging and Radiation Oncology 52 (2): 109–17. April 2008. doi:10.1111/j.1440-1673.2008.01926.x. PMID 18373800.
- ↑ "A case of gallbladder cancer arising from the Rokitansky-Aschoff sinus". Japanese Journal of Clinical Oncology 39 (11): 776. November 2009. doi:10.1093/jjco/hyp149. PMID 19884193.
- ↑ 8.0 8.1 8.2 "Pathogenesis of gallbladder adenomyomatosis and its relationship with early-stage gallbladder carcinoma: an overview". Brazilian Journal of Medical and Biological Research 51 (6): e7411. 2018. doi:10.1590/1414-431x20187411. PMID 29791592.
- ↑ "MR diagnosis of adenomyomatosis of the gallbladder and differentiation from gallbladder carcinoma: importance of showing Rokitansky-Aschoff sinuses". AJR. American Journal of Roentgenology 172 (6): 1535–40. June 1999. doi:10.2214/ajr.172.6.10350285. PMID 10350285.
- ↑ synd/983 at Who Named It?
- ↑ "Eponyms in radiology of the digestive tract: historical perspectives and imaging appearances. Part 2. Liver, biliary system, pancreas, peritoneum, and systemic disease". Radiographics 26 (2): 465–80. 2005. doi:10.1148/rg.262055130. PMID 16549610.
External links
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