Adenomyomatosis is a benign condition characterized by

hyperplastic Hyperplasia (from ancient Greek ὑπέρ ''huper'' 'over' + πλάσις ''plasis'' 'formation'), or hypergenesis, is an enlargement of an organ or tissue caused by an increase in the amount of organic tissue that results from cell proliferatio ...

changes of unknown cause involving the wall of the gallbladder. Adenomyomatosis is caused by an overgrowth of the mucosa, thickening of the muscular wall, and formation of intramural diverticula or sinus tracts termed Rokitansky–Aschoff sinuses, also called entrapped epithelial crypts.

Signs and symptoms

Pathophysiology

Rokitansky–Aschoff sinuses

Rokitansky–Aschoff sinuses are pseudodiverticula or pockets in the wall of the

gallbladder In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although ...

. They may be microscopic or macroscopic.

Histological Histology, also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures vis ...

ly, they are outpouchings of gallbladder

mucosa A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...

into the gallbladder

muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...

layer and subserosal tissue as a result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall. Rokitansky–Aschoff sinuses are not of themselves considered abnormal but they can be associated with

cholecystitis Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede acute cholecystitis. The pain l ...

. They form as a result of increased pressure in the gallbladder and recurrent damage to the wall of the gallbladder.

Associations

Black pigment gallstones can form in Rokitansky–Aschoff sinuses of the gallbladder after the fourth to fifth decades of life in absence of the typical risk factors for bilirubin supersaturation of bile. Hence, they are associated with gallstones (

cholelithiasis A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of migr ...

). Cases of gall bladder cancer have also been reported to arise from Rokitansky–Aschoff sinuses.

Diagnosis

Abdominal ultrasound Abdominal ultrasonography (also called abdominal ultrasound imaging or abdominal sonography) is a form of medical ultrasonography (medical application of ultrasound technology) to visualise abdominal anatomical structures. It uses transmission a ...

has low accuracy in differentiating gall bladder adenomyomatosis from cancer and is operator dependent. However, it is used as the exam of the first-line due to its wide availability. Ultrasound findings may show thickened gall bladder wall, tiny anechoic spaces (Rokitansky–Aschoff sinuses or RAS), and twinkling artifact (or comet-tail reverberation). Comet tail reverberation, which is due to reflections from cholesterol crystals, is a highly specific sign for adenomyomatosis. On CT scan, it may show rosary sign, showing mucosal epithelium with intramural diverticula.

Magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...

also plays an important role in the diagnosis of Rokitansky–Aschoff sinuses. In fat-suppression MRI, RAS present with small, rounded, high signal intensity foci, called “pearl necklace sign”.

Eponym

Rokitansky–Aschoff sinuses are named after

Carl Freiherr von Rokitansky Baron Carl von Rokitansky (german: Carl Freiherr von Rokitansky, cs, Karel Rokytanský; 19 February 1804 – 23 July 1878) was a Bohemian physician, pathologist, humanist philosopher and liberal politician, founder of the Viennese School of Me ...

(1804–1878), a pathologist in Vienna, Austria and

Ludwig Aschoff Karl Albert Ludwig Aschoff (10 January 1866 – 24 June 1942) was a German physician and pathologist. He is considered to be one of the most influential pathologists of the early 20th century and is regarded as the most important German patholog ...

(1866–1942), a pathologist in Bonn, Germany.

References

External links

* {{Gastroenterology Gallbladder disorders Hepatology