I. Classification
1, diffuse type (diffuse thickening of the entire gallbladder wall)
2, segmental (in the thickened wall of the middle section of the gallbladder appears ring-like narrowing, separating the gallbladder into two small interconnected cavities, so that the gallbladder resembles a gourd)
3.Confined, also called basal type (the wall at the bottom of the gallbladder is restrictedly hyperplastic), which is more common. It is not easy to make a diagnosis before surgery and is considered a precancerous lesion.
Clinical manifestations and diagnosis
The symptoms are similar to those of cholecystitis and cholelithiasis, and mostly coexist with both of them. The diagnosis can be made by the detection of R-A sinus on imaging examination. The gallbladder of patients with post-feeding cholecystic adenomyosis is hypercontracted, and the performance of lipid meal test is different from that of cholecystitis and gallbladder cancer.
Clinical manifestations and diagnosis
Differential diagnosis.
Limited type: with gallbladder cancer and gallbladder polyps
Diffuse type: with chronic cholecystitis
Segmental type: congenital septum of gallbladder, distortion and folding of gallbladder
IV. Treatment
Surgical indications (there is no uniform standard yet).
Some scholars believe that adenomyosis of the gallbladder is a precancerous lesion of gallbladder cancer, and it is easily complicated by gallbladder stones, so it should be operated immediately upon diagnosis
Some scholars consider suspected cancer or combined with stones as indications for surgery
Problem: The diagnosis ultimately depends on pathology, and preoperative diagnosis is difficult
Non-inflammatory thickening or irregular thickening of the gallbladder wall > 5 mm on ultrasound should be highly suspicious for adenomyosis of the gallbladder and imaging indications for surgery
Gallbladder cancer
V. Classification
Papillary type, nodular type, infiltrative type
Mostly located at the base and neck of gallbladder
The first two types are elevated lesions, while the majority of papillary adenocarcinomas are confined to the mucosal and muscular layers, with good prognosis.
Clinical manifestations and diagnosis
Lack of specificity, the most common symptom is right upper abdominal pain
Imaging: Irregular gallbladder contour, thickened wall, nodule-like or cauliflower-like elevation
Ultrasound is preferred, and endoscopic ultrasound can determine the degree of tumor infiltration, area and the presence of lymph node metastasis
CT, MRI: enlarged or shrunken gallbladder, irregular thickening of the wall, enhancement, adjacent liver invasion
Ultrasound imaging of the epigastrium is characterized by: tumor larger than 10mm, especially larger than 15mm, solitary, mostly located in the neck of gallbladder, and 50% may be accompanied by stones.
VII. Treatment
Surgery.
Treatment for polyp-type early gallbladder cancer: once suspected, radical cholecystectomy should be performed instead of traditional cholecystectomy. The loose connective tissue above and below the gallbladder duct should be removed together with the fibrofatty tissue on the liver bed, and postoperative chemotherapy and follow-up should be given according to the situation.
Principles of management of proliferative gallbladder disease: Ultrasound examination of the upper abdomen (once every 3 to 6 months) for changes in the disease. Surgery is required when the following conditions are present: lesion diameter greater than 10 mm, broad-based solitary lesion with a tendency to increase in size, age greater than 50 years, gallbladder polyp-like lesion combined with gallbladder stones.