A 48-year-old woman undergoes cholecystectomy for acute cholecystitis. Histopathology of the gallbladder shows diffuse mucosal thickening with intramural diverticula (Rokitansky-Aschoff sinuses), smooth muscle hypertrophy, and no evidence of malignancy. This diagnosis is best classified as:

• A Cholesterolosis of the gallbladder (strawberry gallbladder)
• B Porcelain gallbladder
• C Adenomyomatosis of the gallbladder ✓
• D Xanthogranulomatous cholecystitis

Explanation

Adenomyomatosis of the gallbladder is a hyperplastic lesion characterised by mucosal epithelial proliferation, smooth muscle hypertrophy, and formation of deep intramural diverticula (Rokitansky-Aschoff sinuses — herniation of epithelium through the muscle layer into or beyond the muscularis). On ultrasound it shows the characteristic 'comet-tail' artefact (ring-down artefact) due to cholesterol crystals within Rokitansky-Aschoff sinuses. It is generally considered benign with no definitive malignant association. Cholesterolosis involves lipid-laden macrophage accumulation in the lamina propria without muscle hypertrophy. Porcelain gallbladder involves dystrophic calcification of the wall. Xanthogranulomatous cholecystitis involves lipid-laden foamy macrophages, bile extravasation, and fibrosis mimicking malignancy.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.