Adenomyomas of the gallbladder: An analysis of frequency, clinicopathologic associations, and relationship to carcinoma of a malformative lesion

Abstract

Context.—The nature and associations of gallbladder (GB) ‘‘adenomyoma’’ (AM) remain controversial. Some studies have attributed up to 26% of GB carcinoma to AMs. Objective.—To examine the true frequency, clinicopathologic characteristics, and neoplastic changes in GB AM. Design.—Cholecystectomy cohorts analyzed were 1953 consecutive cases, prospectively with specific attention to AM; 2347 consecutive archival cases; 203 totally embedded GBs; 207 GBs with carcinoma; and archival search of institutions for all cases diagnosed as AM. Results.—Frequency of AM was 9.3% (19 of 203) in totally submitted cases but 3.3% (77 of 2347) in routinely sampled archival tissue. A total of 283 AMs were identified, with a female to male ratio ¼ 1.9 (177:94) and mean size ¼ 1.3 cm (range, 0.3–5.9). Most (96%, 203 of 210) were fundic, with formed nodular trabeculated submucosal thickening, and were difficult to appreciate from the mucosal surface. Four of 257 were multifocal (1.6%), and 3 of 257 (1.2%) were extensive (‘‘adenomyomatosis’’). Dilated glands (up to 14 mm), often radially converging to a point in the mucosa, were typical. Muscle was often minimal, confined to the upper segment. Nine of 225 (4%) revealed features of a duplication. No specific associations with inflammation, cholesterolosis, intestinal metaplasia, or thickening of the uninvolved GB wall were identified. Neoplastic change arising in AM was seen in 9.9% (28 of 283). Sixteen of 283 (5.6%) had mural intracholecystic neoplasm; 7 of 283 (2.5%) had flat-type high-grade dysplasia/carcinoma in situ. Thirteen of 283 cases had both AM and invasive carcinoma (4.6%), but in only 5 of 283 (1.8%), carcinoma was arising from AM (invasion was confined to AM, and dysplasia was predominantly in AM). Conclusions.—AMs have all the features of a malformative developmental lesion, and may not show a significant muscle component; (ie, the name ‘‘adeno-myoma’’ is partly a misnomer). While most are innocuous, some pathologies may arise in AMs, including intracholecystic neoplasms, flattype high-grade dysplasia or carcinoma in situ and invasive carcinoma (1.8%, 5 of 283). It is recommended that gross examination of GBs include serial slicing of the fundus for AM detection and total submission if one is found.