- Comparison of DWIBS/T2 image fusion and PET/CT for the diagnosis of cancer in the abdominal cavity. [Journal Article]
- ETExp Ther Med 2017; 14(4):3754-3760
- Fusion images of diffusion-weighted whole-body imaging with background body signal suppression and T2-weighted image (DWIBS/T2) demonstrate a strong signal for malignancies, with a high contrast agai...
Fusion images of diffusion-weighted whole-body imaging with background body signal suppression and T2-weighted image (DWIBS/T2) demonstrate a strong signal for malignancies, with a high contrast against the surrounding tissues, and enable anatomical analysis. In the present study, DWIBS/T2 was compared with (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) for diagnosing cancer in the abdomen. Patient records, including imaging results of examination conducted between November 2012 and May 2014, were analyzed retrospectively. In total, 10 men (age, 73.6±9.6 years) and 8 women (age, 68.9±7.1 years) were enrolled into the current study. Of the enrolled patients, 2 were diagnosed with hepatocellular carcinoma, 1 with cholangiocellular carcinoma, 1 with liver metastasis, 2 with pancreatic ductal adenocarcinoma, 1 with renal cell carcinoma and 1 with malignant lymphoma. Benign lesions were also analyzed, including adenomyomatosis of the gallbladder (5 patients), intraductal papillary mucinous neoplasm (4 patients) and right adrenal adenoma (1 case). All the patients with cancer showed positive results on DWIBS/T2 images. However, only 7 out of 8 patients were positive with PET/CT. One patient with right renal cellular carcinoma was positive with DWIBS/T2, but negative with PET/CT. All the patients with benign lesions were negative with DWIBS/T2 and PET/CT. In conclusion, DWIBS/T2 was more sensitive in diagnosing cancer of organs in the abdominal cavity compared with PET/CT. Furthermore, negative results with DWIBS/T2 and PET/CT were useful for the diagnosis of benign lesions, such as adenomyomatosis of the gallbladder and intraductal papillary mucinous neoplasm.
- Gallbladder adenomyomatosis: Diagnosis and management. [Journal Article]
- JVJ Visc Surg 2017; 154(5):345-353
- Gallbladder (GB) adenomyomatosis (ADM) is a benign, acquired anomaly, characterized by hypertrophy of the mucosal epithelium that invaginates into the interstices of a thickened muscularis forming so...
Gallbladder (GB) adenomyomatosis (ADM) is a benign, acquired anomaly, characterized by hypertrophy of the mucosal epithelium that invaginates into the interstices of a thickened muscularis forming so-called Rokitansky-Aschoff sinuses. There are three forms of ADM: segmental, fundal and more rarely, diffuse. Etiology and pathogenesis are not well understood but chronic inflammation of the GB is a necessary precursor. Prevalence of ADM in cholecystectomy specimens is estimated between 1% and 9% with a balanced sex ratio; the incidence increases after the age of 50. ADM, although usually asymptomatic, can manifest as abdominal pain or hepatic colic, even in the absence of associated gallstones (50% to 90% of cases). ADM can also be revealed by an attack of acalculous cholecystitis. Pre-operative diagnosis is based mainly on ultrasound (US), which identifies intra-parietal pseudo-cystic images and "comet tail" artifacts. MRI with MRI cholangiography sequences is the reference examination with characteristic "pearl necklace" images. Symptomatic ADM is an indication for cholecystectomy, which results in complete disappearance of symptoms. Asymptomatic ADM is not an indication for surgery, but the radiological diagnosis must be beyond any doubt. If there is any diagnostic doubt about the possibility of GB cancer, a cholecystectomy is justified. The discovery of ADM in a cholecystectomy specimen does not require special surveillance.
- Gallbladder Adenomyomatosis Mimicking Carcinoma: A Diagnostic Dilemma. [Journal Article]
- JGJ Glob Oncol 2016; 2(5):341-345
- Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of localized gallbladder lesions. [Journal Article]
- DEDig Endosc 2018; 30(1):98-106
- CONCLUSIONS: CH-EUS was useful for the evaluation of localized gallbladder lesions.
- Adenomyomatosis Concomitant with Primary Gallbladder Carcinoma. [Journal Article]
- AMActa Med Okayama 2017; 71(2):113-118
- Some clinicians have proposed a relationship between gallbladder (GB) cancer and adenomyomatosis (ADM) of the gallbladder, although the latter condition is not considered to have malignant potential....
Some clinicians have proposed a relationship between gallbladder (GB) cancer and adenomyomatosis (ADM) of the gallbladder, although the latter condition is not considered to have malignant potential. We retrospectively reviewed the surgical pathology database of patients who underwent resection for ADM of the gallbladder at our institution from March 2005 to May 2015. In total, 624 patients underwent surgical resection of the gallbladder with Rokitansky-Aschoff sinuses. Of these cases, 93 were pathologically diagnosed with ADM of the gallbladder, with 44 (47.3%) classified macroscopically as fundal-type ADM, 26 (28.0%) as segmental type, and 23 (24.7%) as diffuse-type ADM. In 3 of the 93 (3.2%) resected specimens, early-stage GB carcinoma was detected, although preoperative imaging did not suggest a malignant neoplasm of the gallbladder in any of these patients. GB cancer subsequently developed in the mucosa of the fundal compartment distal to the annular stricture of the segmental-type ADM in 2 of these patients and against the background of the fundal-type ADM in 1 patient. This study revealed the difficulty of early diagnosis of primary GB cancer in the setting of concurrent ADM, and clinicians should be aware of this frequent coexistence.
- A case of intracystic papillary neoplasm of the gallbladder that exhibited findings similar to gallbladder adenomyomatosis with the formation of intramural cysts because of Rokitansky-Aschoff sinus infiltration. [Case Reports]
- NSNihon Shokakibyo Gakkai Zasshi 2017; 114(2):264-273
- A 74-year-old man underwent regular follow-up observations after being diagnosed with gallbladder adenomyomatosis based on findings, such as the thickening of the wall of the gallbladder fundus and t...
A 74-year-old man underwent regular follow-up observations after being diagnosed with gallbladder adenomyomatosis based on findings, such as the thickening of the wall of the gallbladder fundus and the presence of intramural cysts. Over the course of 3 years, a papillary tumor located on the thickened wall of the gallbladder had increased in size and extended into the lumen. Consequently, the patient was diagnosed with gallbladder cancer and underwent extended cholecystectomy. The histological diagnosis was intracystic papillary neoplasm (ICPN) of the gallbladder. Although several Rokitansky-Aschoff sinuses that had increased in size because of tumor progression were observed, no adenomyomatosis of the gallbladder was detected. ICPN, a recently identified disease, is not widely known to present with imaging findings similar to adenomyomatosis. The primary treatment of ICPN is radical resection, whereas adenomyomatosis is generally conservatively managed with regular follow-up observations. As the treatment strategies for these two diseases greatly differ, differential diagnosis must be carefully performed.
- [Clinicopathological Study of Incidental Gallbladder Cancer Diagnosed after Laparoscopic Cholecystectomy]. [Journal Article]
- GTGan To Kagaku Ryoho 2016; 43(12):1605-1607
- The aim of this study was to clarify the clinicopathological characteristics of incidental gallbladder cancer(iGBC)diagnosed after laparoscopic cholecystectomy. A total of 33 patients diagnosed with ...
The aim of this study was to clarify the clinicopathological characteristics of incidental gallbladder cancer(iGBC)diagnosed after laparoscopic cholecystectomy. A total of 33 patients diagnosed with iGBC were enrolled in this study, and their clinicopathological characteristics were investigated. Preoperative diagnoses were as follows: cholelithiasis in 16 patients, polypoid lesions in 8, cholecystitis in 7, and adenomyomatosis in 2. Depth of mural invasion of iGBC was M in 14 cases, MP in 3, SS in 12, and deeper than SS in 4. M/MP cases with negative margins were followed up, and cases with SS/deeper than SS underwent additional resection. Prognosis of these patients with iGBC was not significantly different from that of non-iGBC (niGBC)patients. There was no significant difference in R2 resection rate between iGBC and niGBC with SS/deeper than SS. Intriguingly, peritoneal dissemination was identified on additional resection in 1 case that had intraoperative bile leakage at the prior laparoscopic cholecystectomy. Port-site recurrence was found in 2 iGBC cases. These results suggested that the treatment strategy for iGBC is acceptable. However, considering the existence of cases with peritoneal dissemination or portsite recurrence, the possible presence of iGBC should be kept in mind at the initial laparoscopic cholecystectomy.
- Gallbladder adenomyomatosis: imaging findings, tricks and pitfalls. [Review]
- IIInsights Imaging 2017; 8(2):243-253
- Gallbladder adenomyomatosis (GA) is a benign alteration of the gallbladder wall that can be found in up to 9% of patients. GA is characterized by a gallbladder wall thickening containing small bile-f...
Gallbladder adenomyomatosis (GA) is a benign alteration of the gallbladder wall that can be found in up to 9% of patients. GA is characterized by a gallbladder wall thickening containing small bile-filled cystic spaces (i.e., the Rokitansky-Aschoff sinuses, RAS). The bile contained in RAS may undergo a progressive concentration process leading to crystal precipitation and calcification development. A correct characterization of GA is fundamental in order to avoid unnecessary cholecystectomies. Ultrasound (US) is the imaging modality of choice for diagnosing GA; the use of high-frequency probes and a precise focal depth adjustment enable correct identification and characterization of GA in the majority of cases. Contrast-enhanced ultrasound (CEUS) can be performed if RAS cannot be clearly identified at baseline US: RAS appear avascular at CEUS, independently from their content. Magnetic resonance imaging (MRI) should be reserved for cases that are unclear on US and CEUS. At MRI, RAS can be identified with extremely high sensitivity, but their signal intensity varies widely according to their content. Positron emission tomography (PET) may be helpful for excluding malignancy in selected cases. Computed tomography (CT) and cholangiography are not routinely indicated in the suspicion of GA.
- Gallbladder adenomyomatosis: not always benign. [Letter]
- HHPB (Oxford) 2017; 19(6):557
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- JOJ Obstet Gynaecol 2017; 37(1):118-120