Gallbladder adenomyomatosis is divided into three types depending on the location or the extent of involvement: diffuse, segmental, and localized. No malignant cell was detected.Īdenomyomatosis or adenomyomatous hyperplasia of the gallbladder is a common benign disease, identified in approximately 9% of specimens obtained after cholecystectomy ( 3). There were scanty inflammatory cells and fibrosis around the protruded gallbladder adenomyomatosis and adjacent colonic wall. The surface of the mass was covered with a gallbladder mucosa and was continuous with colonic mucosa ( Fig. Histopathologically, the mass was composed of polypoid growth of gallbladder adenomyomatous hyperplasia. Gross pathologic specimen revealed a polypoid mass in the colonic lumen that had protruded from the gallbladder fundus ( Fig. As the mass was adherent to the liver parenchyma, radical cholecystectomy which removes both the gallbladder and a part of the liver was performed. In line with the CT images, the colonic mass was found to be adjoining the gallbladder during the surgery. The patient underwent right hemicolectomy. Based on the CT findings, colon cancer with gallbladder and liver invasion was strongly suggested. There were no significantly enlarged regional lymph nodes. The mass was closely abutting the liver causing tethered appearance of the liver surface ( Fig. The polyp had lobulated surface, without an overlying colonic mucosa. The mass was extending to the adjacent gallbladder fundus accompanying a 1 cm gallbladder stone. Abdominal CT depicted a 3 cm heterogeneously enhancing polypoid intraluminal mass in the hepatic flexure of the colon. Rokitansky-Aschoff sinuses are located in the hypertrophied muscular layer, suggesting adenomyomatous hyperplasia (hematoxylin and eosin stain, × 40).Ī contrast-enhanced computed tomography (CT) scan was performed for further evaluation. Photomicrograph reveals the mass composed of gallbladder mucosa (arrowhead), connected to the atrophied colonic mucosa (arrow).

Gross specimen shows brownish polypoid mass arising from the gallbladder, same color as gallbladder mucosa.ĭ. Colon cancer with gallbladder and liver invasion was highly suspected.Ĭ. On coronal image, this mass is closely abutting the adjacent liver parenchyma, causing tethered appearance of the liver surface (arrow). Axial image of contrast enhanced CT scan depicts a heterogeneous enhancing intraluminal polypoid mass in the hepatic flexure of the colon (arrow), with extension to the adjacent gallbladder fundus (arrowhead). The colonoscopy shows a 3 cm polypoid mass with ulceration, mucosal denudation in the stalk, and the mucosa of the mass is different from the colonic mucosa.ī.

Localized adenomyomatosis of gallbladder in 62-year-old female patient initially misdiagnosed as an advanced hepatic flexure colon cancer. The biopsy of the polyp obtained during the second colonoscopy came back as an inflammatory polyp. Since the polyp failed to be lifted after the injection, the patient was further consulted for the surgical resection with the diagnostic impression of a colon cancer that had invaded beyond the submucosal layer. Under the suspicion for a malignant polyp, indigo carmine solution was injected in the submucosal layer of the nearby colon for polypectomy. The mucosal surface of the mass showed different nature from that of the normal colonic mucosa, and had an ulceration as well as denudation at the stalk and the base of the polyp. A repeat colonoscopy for a planned polypectomy revealed a polypoid mass in the hepatic flexure of the colon ( Fig. Laboratory tests were within the normal limits, except for mildly elevated C-reactive protein (0.91 mg/dL). She had no relevant past history and was symptomless. A 62-year-old woman was referred to our hospital for an incidentally found colonic polyp on a screening colonoscopy.

Hepatic flexture