PMC6907037_01
Abdominal contrast-enhanced computed tomography revealed a circular solid mass-like lesion (circle) near the normal-looking gallbladder on admission: (a) axial view, (b) coronal view, and (c) sagittal view.
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Contrast-enhanced CT in axial view in the first radiologic examination showed a circular solid mass-like lesion (30 x 23 mm in diameter) adjacent to the liver that was heterogeneously enhanced with a small luminal structure in the center (Figure 1(a)). The first CT was reconstructed in coronal and sagittal views, and the lesion was recognized as a thickened wall of the entire gallbladder (Figures 1(b) and 1(c)).
Repeated ultrasonography the next day of admission revealed that the proximal dilated gallbladder (arrow) was continuous with the mass (circle), the wall of which contained several small cysts (arrowheads).
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It was continuous to the expanded normal gallbladder wall (Figure 2).
Magnetic resonance cholangiopancreatography revealed a pearl necklace sign (circle), continuous with the proximal gallbladder (arrow), and no other anomalies (e.g., pancreaticobiliary maljunction).
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Magnetic resonance cholangiopancreatography (MRCP) revealed small cysts with an orderly alignment and high-intensity signals in the thickened wall of the body and fundus of the gallbladder, which was regarded as the pearl necklace sign of AMG (Figure 3), and showed no other abnormalities (e.g., pancreaticobiliary maljunction [PBM]).
(a) More than half of the distal wall of the gallbladder was thickened (circle). (b) A histopathological examination revealed that the thickened wall contained Rokitansky-Aschoff sinuses (arrows) combined with hyperplasia of the smooth muscle and collagen fibers, which were compatible with adenomyomatosis of the gallbladder.
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The wall of the middle of the body was far more thickened than that of the peripheral area, causing slight stenosis (Figure 4(a)). The histopathological findings of all areas of the thickened wall contained Rokitansky-Aschoff sinuses (RASs) combined with hyperplasia of the smooth muscle and collagen fibers (Figure 4(b)), which were compatible with AMG, and no malignant or premalignant findings.