Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 464-470
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.464
Utility of multiple endoscopic techniques in differential diagnosis of gallbladder adenomyomatosis from gallbladder malignancy with bile duct invasion: A case report
Li-Jia Wen, Jun-Hong Chen, Yong-Jin Chen, Kai Liu
Li-Jia Wen, Jun-Hong Chen, Yong-Jin Chen, Kai Liu, Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Wen LJ and Liu K were involved in the patient’s medical treatment and wrote the paper; Chen JH and Chen YJ gathered detailed clinical information and contributed to preparing the figures; and all authors have read and approved the final manuscript.
Supported by the Jilin Province Science and Technology Development Program, No. 20191102031YY.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kai Liu, PhD, Chief Doctor, Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun 130021, Jilin Province, China. 6kai@163.com
Received: December 2, 2019
Peer-review started: December 2, 2019
First decision: December 11, 2019
Revised: December 19, 2019
Accepted: December 22, 2019
Article in press: December 22, 2019
Published online: January 26, 2020
Processing time: 45 Days and 11.9 Hours
Abstract
BACKGROUND

Gallbladder adenomyomatosis (GAM) is a benign lesion, characterized by thickening of the gallbladder wall and a focal mass, which overlap with the features of gallbladder malignancy. Consequently, differential diagnosis of GAM from gallbladder cancer is difficult and approximately 20% of suspected malignant biliary strictures are postoperatively confirmed as benign lesions. Herein, we report a case in which a preoperative diagnosis of GAM was made by a combination of endoscopic and imaging techniques.

CASE SUMMARY

A 40-year-old man was referred to our hospital chiefly for a fever and right upper abdominal pain with dark urine. Enhanced computed tomography showed thickening of the gallbladder wall and a mass in the gallbladder neck with involvement of the hepatic bile ducts, which was suspected to be malignant. Gallbladder malignancy with bile duct invasion was ruled out by subsequent endoscopic examinations, including endoscopic retrograde cholangio-pancreatography, intraductal ultrasound, and SpyGlass. Endoscopic examinations showed a homogeneous hyperechoic lesion with smooth margins of benign bile duct stricture suggestive of inflammatory stenosis of the bile duct. The patient underwent laparoscopic cholecystectomy. GAM was postoperatively diagnosed and confirmed based on the histopathology results, which are consistent with the preoperative diagnosis. Notably, no malignant event occurred in the patient during a 12-mo follow-up period.

CONCLUSION

A combination of endoscopic techniques may help in the differential diagnosis of GAM from gallbladder cancer.

Keywords: Gallbladder adenomyomatosis; Differential diagnosis; Endoscopic retrograde cholangio-pancreatography; Intraductal ultrasound; SpyGlass; Case report

Core tips: It remains a challenge to make an accurate preoperative diagnosis of gallbladder adenomyomatosis (GAM) mainly due to the overlapping features between GAM and gallbladder cancer. In this case report, enhanced computed tomography findings were initially indicative of a malignant gallbladder lesions, which were subsequently diagnosed as GAM by a combination of endoscopic techniques. Our findings suggest that multiple endoscopies can improve the accuracy of GAM diagnosis and help in differential diagnosis between GAM and gallbladder cancer.