Palabras clave
Vesícula biliar
Senos de Rockitansky-Aschoff
Reporte de un caso
Resumen
La adenomiomatosis de la vesícula biliar se considera un padecimiento benigno y poco frecuente, con una incidencia aproximada de 2.8-5 %; normalmente es diagnosticada a partir de los 50 a los 60 años, contando con una distribución mayor en mujeres que en hombres. Frecuentemente, los pacientes presentan cuadros clínicos asintomáticos o síntomas inespecíficos (dolor abdominal difuso, náuseas, vómitos, etc.), logrando que esta enfermedad pase desapercibida y sea detectada hasta que se realizan los estudios complementarios para la evaluación del padecimiento de manera incidental; la detección primaria se hace por ultrasonografía. Existen características específicas que sugieren esta lesión, aunque es difícil hacer un diagnóstico definitivo por este estudio, ya que las imágenes pueden ser inespecíficas e imitar malignidad; la resonancia magnética se considera el estándar de oro para el diagnóstico. Si el paciente se presenta asintomático, será suficiente un tratamiento conservador, realizando dos ultrasonidos por año. En cambio, si el paciente presenta sínto-mas, se debe de considerar la colecistectomía laparoscópica.
En este artículo, se presenta el caso de un paciente masculino de 74 años de edad con adenomiomatosis de vesícula biliar manejada con tratamiento conservador, en donde se aborda la importancia de individualizar el manejo en los casos asintomáticos o cuando el abordaje quirúrgico no es una opción. Se reporta el caso de un hombre de 74 años que acude al servicio de imagenología de una unidad privada por referencia del médi-co familiar, al presentar dolor en hipocondrio derecho y distensión abdominal de un mes de evolución que aumenta con el consumo de alimentos colecistoquineticos.
Las pruebas de laboratorio, incluyendo AFP, CA19-9, CEA, SGOT, SGPT, bilirrubina, transaminasas y fosfatasa alcalina estaban dentro de los límites normales. El ultrasonido reveló una masa sólida hipoecoica con límites borrosos y superficie irregular, se observó un engrosamiento de la pared de la vesícula biliar, senos de Roki-tansky-Aschoff, y artefactos en cola de cometa, lo cual es consistente con adenomiomatosis de vesícula biliar de tipo difuso.
Referencias
Chatterjee A, Lopes Vendrami C, Nikolaidis P, Mittal PK, Bandy AJ, Menias CO, et al. Uncommon Intraluminal Tumors of the Gallbladder and Biliary Tract: Spectrum of Imaging Appearances. Radio-Graphics [Internet]. 2019 Mar;39(2):388–412. Availa-ble from: 217 http://pubs.rsna.org/doi/10.1148/rg.2019180164
Pérez-Alonso A, Argote-Camacho Á, Rubio-López J, Del Olmo-Rivas C, Petrone P. Adenomioma-tosis de la vía biliar, incidencia de 10 años y revisión de la bibliografía actual. Rev Colomb Cirugía [Internet]. 2015;30(2):112–8. Available from: https://www.revistacirugia.org/index.php/cirugia/article/view/319
COLQUHOUN J. Adenomyomatosis of the gall-bladder (intramural diverticulosis). Br J Radiol. 223 1961 Feb;34:101–12.
Adusumilli S, Siegelman ES. MR imaging of the gallbladder. Magn Reson Imaging Clin N Am [Internet]. 2002 Feb;10(1):165–84. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1064968903000552
Burgos AM, Csendes A, Villanueva M, Cárde-nas G, Narbona S, Caballero M, et al. Hallazgos clíni-cos e histopatológicos en pacientes con adenomio-matosis vesicular. Rev Chil Cirugía [Internet]. 2016 Sep;68(5):363–7. Available from: http://dx.doi.org/10.1016/j.rchic.2016.06.010
Bang SH, Lee JY, Woo H, Joo I, Lee ES, Han JK, et al. Differentiating between Adenomyomatosis and Gallbladder Cancer: Revisiting a Comparative Study of High- Resolution Ultrasound, Multidetector CT, and MR Imaging. Korean J Radiol [Internet]. 234 2014;15(2):226. Available from: https://www.kjronline.org/DOIx.php?id=10.3348/kjr.2014.15.2.226
Ghersin E, Soudack M, Gaitini D. Twinkling Artifact in Gallbladder Adenomyomatosis. J Ul-trasound Med [Internet]. 2003 Feb;22(2):229–31. Available from: 238http://doi.wiley.com/10.7863/jum.2003.22.2.229
Lee K-F, Hung EHY, Leung HHW, Lai PBS. A narrative review of gallbladder adenomyomatosis: what we need to know. Ann Transl Med [Internet]. 2020 Dec;8(23):1600– 1600. Available from: http://atm.amegroups.com/article/view/55024/html
Ching BH, Yeh BM, Westphalen AC, Joe BN, Qayyum A, Coakley F V. CT Differentiation of Adeno-myomatosis and Gallbladder Cancer. Am J Roent-genol [Internet]. 2007 Jul;189(1):62–6. Available from: http://www.ajronline.org/doi/10.2214/AJR.06.0866
Bonthu S, Parthasarathy M, Sill A, Cun-ningham S. Gallbladder adenomyomatosis: expe-rience at a community teaching hospital. Hpb [Internet]. 2017;19:S107. Available from: 247 http://dx.doi.org/10.1016/j.hpb.2017.02.161
Golse N, Lewin M, Rode A, Sebagh M, Ma-brut J-Y. Gallbladder adenomyomatosis: Diagnosis and management. J Visc Surg [Internet]. 2017 Oct;154(5):345–53. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1878788617300607
Nabatame N, Shirai Y, Nishimura A, Yokoya-ma N, Wakai T, Hatakeyama K. High risk of gallblad-der carcinoma in elderly patients with segmental adenomyomatosis of the gallbladder. J Exp Clin Can-cer Res [Internet]. 2004 Dec 1 [cited 2021 May 4];23(4):593–8. Available from: http://europepmc.org/article/med/15743029
Nishimura A, Shirai Y, Hatakeyama K. Seg-mental adenomyomatosis of the gallbladder predis-poses to cholecystolithiasis. J Hepatobiliary Pancreat Surg. 2004;11(5):342–7.
Kim JH, Jeong IH, Han JH, Kim JH, Hwang JC, Yoo BM, et al. Clinical/pathological analysis of ga-llbladder adenomyomatosis; type and pathogenesis. Hepatogastroenterology [Internet]. 2010;57(99–100):420–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20698201
Hammad AY, Miura JT, Turaga KK, Johnston FM, Hohenwalter MD, Gamblin TC. A literature re-view of radiological findings to guide the diagnosis of gallbladder adenomyomatosis. HPB [Internet]. 2016 Feb;18(2):129–35. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1365182X15000246
Pang L, Zhang Y, Wang Y, Kong J. Pathogene-sis of gallbladder adenomyomatosis and its rela-tionship with early-stage gallbladder carcinoma: an overview. Brazilian J Med Biol Res [Internet]. 2018;51(6):1–5. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2018000600201&tlng=en
Joshi J, KirK L. Adenomyomatosis [Internet]. StatPearls [Internet]. 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482244/
Meguid MM, Aun F, Bradford ML. Adeno-myomatosis of the gallbladder. Am J Surg [Internet]. 1984 Feb;147(2):260–2. Available from: https://linkinghub.elsevier.com/retrieve/pii/0002961084901028
Martin E, Gill R, Debru E. Diagnostic accuracy of transabdominal ultrasonography for gallbladder polyps: systematic review. Can J Surg [Internet]. 2018 Jun 1;61(3):200–7. Available from: http://canjsurg.ca/vol61-issue3/61-3-200/
Hoang VT, Van HAT, Nguyen TTT, Chansomphou V, Trinh CT. Diffuse Gallbladder Ade-nomyomatosis with an Inflammatory Complication in an Adult. Case Rep Gastroenterol 278 [Internet]. 2021 Feb 1;15(1):100–7. Available from: https://dx.doi.org/10.1159/000511762
Tang S, Huang L, Wang Y, Wang Y. Contrast-enhanced ultrasonography diagnosis of fundal loca-lized type of gallbladder adenomyomatosis. BMC Gastroenterol [Internet]. 2015 Dec 5;15(1):99. Avai-lable from: https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-015-0326-y
Shi X-C, Tang S-S, Zhao W. Contrast-enhanced ultrasound imaging characteristics of ma-lignant transformation of a localized type gallblad-der adenomyomatosis: A case report and literature review. J Cancer Res Ther [Internet]. 2018;14(8):263. Available from: http://www.cancerjournal.net/text.asp?2018/14/8/263/183208
Yu MH, Lee JY, Yoon J-H, Baek JH, Han JK, Choi B-I. Color Doppler twinkling artifacts from ga-llbladder adenomyomatosis with 1.8 MHz and 4.0 MHz color Doppler frequencies. Ultrasound Med Biol. 2012 Jul;38(7):1188–94.
Hirsch S M, Palavecino B T, León R B. Arte-facto de centelleo en ultrasonido Doppler color: Más que un incomprendido, un signo de utilidad. Rev Chil Radiol [Internet]. 2011;17(2):82–4. Available from: http://www.scielo.cl/scielo.php script=sci_arttext&pid=S071793082011000200006&lng=en&nrm=iso&tlng=en
Yu MH, Kim YJ, Park HS, Jung S Il. Benign ga-llbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases. World J Gastroenterol [Internet]. 2020 Jun 14;26(22):2967–86. Available from: https://www.wjgnet.com/1007- 297 9327/full/v26/i22/2967.htm
Meacock LM, Sellars ME, Sidhu PS. Evalua-tion of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. Br J Radiol [Internet]. 2010 Jul;83(991):615–27. Available from: https://pubmed.ncbi.nlm.nih.gov/20603412
Michalak M, Milewski T, Żurada A, Pacho R, Snarska J, Kozielec Z. Segmental type of gallbladder adenomyomatosis – Case report and literature re-view. Polish Ann Med [Internet]. 2015 Jun;22(1):55–8. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1230801315000065
Haradome H, Ichikawa T, Sou H, Yoshikawa T, Nakamura A, Araki T, et al. The Pearl Necklace Sign: An Imaging Sign of Adenomyomatosis of the Gallbladder at MR Cholangiopancreatography. Ra-diology [Internet]. 2003 Apr;227(1):80–8. Available from: 308 http://pubs.rsna.org/doi/10.1148/radiol.2271011378
Lee HJ, Chung W-S, Kim JY, An JH, Park S. Chronic inflammation-related radiological findings of gallbladder adenomyomatosis. Jpn J Radiol [Internet]. 2020 May 18;38(5):463–71. Available from: http://link.springer.com/10.1007/s11604-020-00931-7
Oe A, Kawabe J, Torii K, Kawamura E, Kotani J, Hayashi T, et al. Distinguishing benign from malig-nant gallbladder wall thickening using FDG-PET. Ann Nucl Med [Internet]. 2006 314 Dec;20(10):699–703. Available from: http://link.springer.com/10.1007/BF02984683
Available from: http://link.springer.com/10.1007/BF02984683
Rodríguez-Fernández A, Gómez-Río M, Lla-mas-Elvira JM, Ortega-Lozano S, Ferrón-Orihuela JA, Ramia-Angel JM, et al. Positron-emission tomo-graphy with fluorine-18-fluoro-2-deoxy-D- glucose for gallbladder cancer diagnosis. Am J Surg [Internet]. 2004 Aug;188(2):171–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002961004001412
Bonatti M, Vezzali N, Lombardo F, Ferro F, Zamboni G, Tauber M, et al. Gallbladder adenomyo-matosis: imaging findings, tricks and pitfalls. Insights Imaging [Internet]. 2017 Apr 321 26;8(2):243–53. Available from: http://dx.doi.org/10.1007/s13244-017-0544-7
Kinoshita H, Ariga H, Shirota J, Sasaki K, Shi-bukawa Y, Fukuda Y, et al. Combined Fundal and Segmental Adenomyomatosis of the Gallbladder in a Child: A Rare Case Report. Case Rep Pediatr [Internet]. 2019 Nov 28;2019:1–4. Available from: https://pubmed.ncbi.nlm.nih.gov/31871811
Kai K, Ide T, Masuda M, Kitahara K, Miyoshi A, Miyazaki K, et al. Clinicopathologic features of advanced gallbladder cancer associated with adeno-myomatosis. Virchows Arch [Internet]. 328 2011 Dec 26;459(6):573–80. Available from: http://link.springer.com/10.1007/s00428 011- 3291155-1
Ootani T, Shirai Y, Tsukada K, Muto T. Relations-hip between gallbladder carcinoma and the seg-mental type of adenomyomatosis of the gallblad-der. Cancer [Internet]. 1992 Jun 1;69(11):2647–52. Available from: https://onlinelibrary.wiley.com/doi/10.1002/1097- 333 0142(19920601)69:11%3C2647::AID-CNCR2820691105%3E3 0.CO;2-0
Pellino G, Sciaudone G, Candilio G, Perna G, Santoriello A, Canonico S, et al. Stepwise approach and surgery for gallbladder adenomyomatosis: a mini-review. Hepatobiliary Pancreat Dis Int [Internet]. 2013 Apr;12(2):136–42. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1499387213600223
Terzi C, Sökmen S, Seçkin S, Albayrak L, UĞurlu M. Polypoid lesions of the gallbladder: Re-port of 100 cases with special reference to operative indications. Surgery [Internet]. 2000 Jun;127(6):622–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0039606000997071
Morikawa T, Okabayashi T, Shima Y, Sumi-yoshi T, Kozuki A, Saisaka Y, et al. Adenomyomatosis Concomitant with Primary Gallbladder Carcinoma. Acta Med Okayama 344 [Internet]. 2017 Apr;71(2):113–8. Available from: http://dx.doi.org/10.18926/AMO/54979
Agrusti A, Gregori M, Salviato T, Codrich D, Barbi E. Adenomyomatosis of the Gallbladder as a Cause of Recurrent Abdominal Pain. J Pediatr [Internet]. 2018 Nov;202:328-328.e1. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022347618306760 348
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.