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CT Differentiation of Adenomyomatosis and Gallbladder Cancer

Brian H. Ching1, Benjamin M. Yeh1, Antonio C. Westphalen1, Bonnie N. Joe1, Aliya Qayyum1 and Fergus V. Coakley1

1 All authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Box 0628, Room M372, San Francisco, CA 94143-0628.


Figure 1
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  		Fig. 1 —53-year-old woman with right upper quadrant pain. Axial contrast-enhanced CT image shows focal gallbladder wall thickening at gallbladder fundus (arrow) appears to contain multiple small cystic spaces. Both reviewers considered this case definite adenomyomatosis, and diagnosis was confirmed at histopathologic examination.

 

Figure 2
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  		Fig. 2 —63-year-old man referred to our institution after laparoscopic cholecystectomy at another hospital was aborted because of finding of apparent gallbladder cancer. Axial contrast-enhanced CT image shows irregular, masslike, solid-appearing gallbladder wall thickening (white arrow) associated with indistinct interface (black arrow) with adjacent liver. Both reviewers considered this lesion definite gallbladder cancer, which was confirmed at histopathologic examination. Hepatic invasion was present at surgery.

 

Figure 3
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  		Fig. 3 —80-year-old woman with microhematuria. Axial contrast-enhanced CT image shows 1-cm solid-appearing nodule at gallbladder fundus (arrow) that was considered likely malignant by reviewer 1 and adenomyomatosis by reviewer 2. Histopathologic analysis showed adenomyomatosis.

 

Figure 4
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  		Fig. 4 —70-year-old woman with painless obstructive jaundice. Axial contrast-enhanced CT image shows hourglass configuration of gallbladder and suggestion of intramural diverticula in fundus (arrow). Histopathologic analysis did not show macroscopic evidence of malignant tumor of gallbladder, but foci of malignant cells were found in gallbladder wall at microscopy and were considered indicative of primary gallbladder cancer.

 

Figure 5
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  		Fig. 5 —62-year-old woman who underwent staging of known gastric cancer. Axial contrast-enhanced CT image shows irregular thickening of gallbladder wall at fundus (arrow) considered likely adenomyomatosis by reviewer 2. Incidental finding of gallbladder cancer was made at surgery.

 

Figure 6
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  		Fig. 6 —73-year-old woman with abdominal pain. Axial contrast-enhanced CT image shows solid-appearing thickening of gallbladder wall at fundus (arrow) considered likely malignant by reviewer 2. Only adenomyomatosis was found at histopathologic review. Large right parapelvic cyst is seen as incidental finding.

 

Figure 7
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  		Fig. 7 —84-year-old woman with abdominal pain. Axial contrast-enhanced CT image shows cystic-appearing thickening of gallbladder wall at fundus (arrow) considered likely adenomyomatosis by reviewers 1 and 2. Only finding at histopathologic review was 5-mm malignant tumor in gallbladder neck.

 

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