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Hyperplastic Cholecystoses
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Cholesterolosis: Strawberry gallbladder (GB), cholesterol polyp
          • Adenomyomatosis: GB diverticulosis, cholecystitis glandularis proliferans, adenomyomatous hyperplasia
        • Definitions

          • Idiopathic, nonneoplastic, and noninflammatory proliferative disorder that results in GB wall thickening
            • Subclassified into 2 entities
            • Adenomyomatosis
              • Mural GB wall thickening due to exaggeration of normal luminal epithelial folds and formation of intramural diverticula (Rokitansky-Aschoff sinuses) in conjunction with smooth muscle and GB epithelial proliferation
            • Cholesterolosis
              • Deposition of foamy, cholesterol-laden histiocytes in subepithelium of GB
              • Numerous small accumulations (strawberry GB) or larger polypoid deposit (cholesterol polyp)

        IMAGING

        • General Features

          • CT Findings

            • MR Findings

              • Ultrasonographic Findings

                • Radiographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Jonathan K et al: Adenomyomatosis. StatPearls, 2021
                                        2. Gupta P et al: Imaging-based algorithmic approach to gallbladder wall thickening. World J Gastroenterol. 26(40):6163181, 2020
                                        3. Yu MH et al: Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases. World J Gastroenterol. 26(22):2967-86, 2020
                                        4. Kania L et al: Interpreting body MRI cases: classic findings in abdominal MRI. Abdom Radiol (NY). 43(10):2790-808, 2018
                                        5. Golse N et al: Gallbladder adenomyomatosis: diagnosis and management. J Visc Surg. 154(5):345-53, 2017
                                        6. Wiles R et al: Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery-European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol. 27(9):3856-66, 2017
                                        7. Revzin MV et al: The gallbladder: uncommon gallbladder conditions and unusual presentations of the common gallbladder pathological processes. Abdom Imaging. 40(2):385-99 2014
                                        8. Nguyen MS et al: Adenomyomatosis. Ultrasound Q. 29(3):215-7, 2013
                                        9. Pellino G et al: Stepwise approach and surgery for gallbladder adenomyomatosis: a mini-review. Hepatobiliary Pancreat Dis Int. 12(2):136-42, 2013
                                        10. Ogawa T et al: High b-value diffusion-weighted magnetic resonance imaging for gallbladder lesions: differentiation between benignity and malignancy. J Gastroenterol. 47(12):1352-60, 2012
                                        11. Yu MH et al: Color Doppler twinkling artifacts from gallbladder adenomyomatosis with 1.8 MHz and 4.0 MHz color Doppler frequencies. Ultrasound Med Biol. 38(7):1188-94, 2012
                                        12. Kim JH et al: Clinical/pathological analysis of gallbladder adenomyomatosis; type and pathogenesis. Hepatogastroenterology. 57(99-100):420-5, 2010
                                        13. Baldwin SL: Gallbladder disease: imaging and treatment. Radiol Technol. 80(2):131-45, 2008
                                        14. Catalano OA et al: MR imaging of the gallbladder: a pictorial essay. Radiographics. 28(1):135-55; quiz 324, 2008
                                        15. Poonam Y et al: Clinics in diagnostic imaging (121). Gallbladder adenomyomatosis. Singapore Med J. 49(3):262-4; quiz 265, 2008
                                        16. Ching BH et al: CT differentiation of adenomyomatosis and gallbladder cancer. AJR Am J Roentgenol. 189(1):62-6, 2007
                                        17. Yoon JH et al: Gallbladder adenomyomatosis: imaging findings. Abdom Imaging. 31(5):555-63, 2006
                                        18. Ghersin E et al: Twinkling artifact in gallbladder adenomyomatosis. J Ultrasound Med. 22(2):229-31, 2003
                                        19. Haradome H et al: The pearl necklace sign: an imaging sign of adenomyomatosis of the gallbladder at MR cholangiopancreatography. Radiology. 227(1):80-8, 2003
                                        20. Owen CC et al: Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis. Semin Gastrointest Dis. 14(4):178-88, 2003
                                        21. Yoshimitsu K et al: Radiologic diagnosis of adenomyomatosis of the gallbladder: comparative study among MRI, helical CT, and transabdominal US. J Comput Assist Tomogr. 25(6):843-50, 2001
                                        22. Berk RN et al: The hyperplastic cholecystoses: cholesterolosis and adenomyomatosis. Radiology. 146(3):593-601, 1983
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Synonyms

                                                • Cholesterolosis: Strawberry gallbladder (GB), cholesterol polyp
                                                • Adenomyomatosis: GB diverticulosis, cholecystitis glandularis proliferans, adenomyomatous hyperplasia
                                              • Definitions

                                                • Idiopathic, nonneoplastic, and noninflammatory proliferative disorder that results in GB wall thickening
                                                  • Subclassified into 2 entities
                                                  • Adenomyomatosis
                                                    • Mural GB wall thickening due to exaggeration of normal luminal epithelial folds and formation of intramural diverticula (Rokitansky-Aschoff sinuses) in conjunction with smooth muscle and GB epithelial proliferation
                                                  • Cholesterolosis
                                                    • Deposition of foamy, cholesterol-laden histiocytes in subepithelium of GB
                                                    • Numerous small accumulations (strawberry GB) or larger polypoid deposit (cholesterol polyp)

                                              IMAGING

                                              • General Features

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Radiographic Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Jonathan K et al: Adenomyomatosis. StatPearls, 2021
                                                                              2. Gupta P et al: Imaging-based algorithmic approach to gallbladder wall thickening. World J Gastroenterol. 26(40):6163181, 2020
                                                                              3. Yu MH et al: Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases. World J Gastroenterol. 26(22):2967-86, 2020
                                                                              4. Kania L et al: Interpreting body MRI cases: classic findings in abdominal MRI. Abdom Radiol (NY). 43(10):2790-808, 2018
                                                                              5. Golse N et al: Gallbladder adenomyomatosis: diagnosis and management. J Visc Surg. 154(5):345-53, 2017
                                                                              6. Wiles R et al: Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery-European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol. 27(9):3856-66, 2017
                                                                              7. Revzin MV et al: The gallbladder: uncommon gallbladder conditions and unusual presentations of the common gallbladder pathological processes. Abdom Imaging. 40(2):385-99 2014
                                                                              8. Nguyen MS et al: Adenomyomatosis. Ultrasound Q. 29(3):215-7, 2013
                                                                              9. Pellino G et al: Stepwise approach and surgery for gallbladder adenomyomatosis: a mini-review. Hepatobiliary Pancreat Dis Int. 12(2):136-42, 2013
                                                                              10. Ogawa T et al: High b-value diffusion-weighted magnetic resonance imaging for gallbladder lesions: differentiation between benignity and malignancy. J Gastroenterol. 47(12):1352-60, 2012
                                                                              11. Yu MH et al: Color Doppler twinkling artifacts from gallbladder adenomyomatosis with 1.8 MHz and 4.0 MHz color Doppler frequencies. Ultrasound Med Biol. 38(7):1188-94, 2012
                                                                              12. Kim JH et al: Clinical/pathological analysis of gallbladder adenomyomatosis; type and pathogenesis. Hepatogastroenterology. 57(99-100):420-5, 2010
                                                                              13. Baldwin SL: Gallbladder disease: imaging and treatment. Radiol Technol. 80(2):131-45, 2008
                                                                              14. Catalano OA et al: MR imaging of the gallbladder: a pictorial essay. Radiographics. 28(1):135-55; quiz 324, 2008
                                                                              15. Poonam Y et al: Clinics in diagnostic imaging (121). Gallbladder adenomyomatosis. Singapore Med J. 49(3):262-4; quiz 265, 2008
                                                                              16. Ching BH et al: CT differentiation of adenomyomatosis and gallbladder cancer. AJR Am J Roentgenol. 189(1):62-6, 2007
                                                                              17. Yoon JH et al: Gallbladder adenomyomatosis: imaging findings. Abdom Imaging. 31(5):555-63, 2006
                                                                              18. Ghersin E et al: Twinkling artifact in gallbladder adenomyomatosis. J Ultrasound Med. 22(2):229-31, 2003
                                                                              19. Haradome H et al: The pearl necklace sign: an imaging sign of adenomyomatosis of the gallbladder at MR cholangiopancreatography. Radiology. 227(1):80-8, 2003
                                                                              20. Owen CC et al: Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis. Semin Gastrointest Dis. 14(4):178-88, 2003
                                                                              21. Yoshimitsu K et al: Radiologic diagnosis of adenomyomatosis of the gallbladder: comparative study among MRI, helical CT, and transabdominal US. J Comput Assist Tomogr. 25(6):843-50, 2001
                                                                              22. Berk RN et al: The hyperplastic cholecystoses: cholesterolosis and adenomyomatosis. Radiology. 146(3):593-601, 1983