Is adenomyomatosis of the gallbladder a cancerous lesion?

Hello doctor,

I am a 59-year-old woman. I have a history of GERD, colon polyps, asthma, anxiety, and depression. Two years ago, I was diagnosed with pancreatitis after a routine endoscopy. After the pancreatitis, I had an MRCP that revealed adenomyomatosis of the gallbladder. For the past few months, I have been having intermittent diarrhea, nausea, stomach pain, and chronic bloating, getting worse in intensity. My doctor did a CT and an ultrasound this week. The only anomaly that imaging revealed is that the adenomyomatosis is now 0.39 inches thick at the fundus.

My questions are:

1. Is that adenomyomatosis very large?

2. Can adenomyomatosis become cancer or hide cancer?

3. Can CT and ultrasound clearly distinguish between cancer and adenomyomatosis on imaging? I am worried that it is cancer. Because I am the sole caregiver to my adult autistic daughter, and she depends on me for everything. I know gallbladder cancer is a certain death.

4. Should I get my gallbladder out?

5. Does the fact that adenomyomatosis was seen on MRCP make it more likely that what the radiologist saw on my ultrasound this week was adenomyomatosis?

I cannot get an appointment with my GI for a month. Kindly suggest.

Here are my ultrasound results if it helps. And below it are the results from an MRCP I had done two years ago.

Recent report-

Examination: Ultrasound of the right upper quadrant.

Clinical information: Abdominal pain, bloating, and diarrhea.

Technical factors: Sagittal and transverse scans of the right upper quadrant were obtained with color Doppler.

Previous reports:

Findings:

Pancreas: No masses. The hypoechoic area with a geographic pattern along the posterior pancreatic head likely represents focal fat. The pancreatic duct is not dilated.

Liver: Diffusely heterogeneous. No masses. The liver measures 5.15 inches.

Gall bladder: No stones. In the fundus, there is an approximately 0.39 inch hypoechoic area likely representing fundal adenomyomatosis. This was not documented on the prior ultrasound but was seen on the CT. The common bile duct measures 0.11 inches in the anteroposterior plane.

Right Kidney: The right kidney measures 4.17 X 1.69 X 1.92 inches. Exophytic 0.62 inches cyst. Adjacent to it is a 6 mm hypoechoic area too small to accurately characterize. Consider a 12-month sonographic follow-up.

Impression: 0.39 inches gallbladder fundal adenomyomatosis. Six-month follow-up is recommended. Indeterminate 0.23 inches hypoechoic exophytic lesion in the mid pole of the right kidney laterally likely a cyst with artifactual echoes. Consider a 24-month sonographic follow-up.

History: Pain and pancreatitis.

Older reports:

Technique: 1.5 Tesla magnet. Axial T2-weighted and T1-weighted imaging, as well as coronal T2-weighted imaging, was performed. Postcontrast T1-weighted imaging was provided following the intravenous administration of 20 mL Dotarem gadolinium contrast. Additional MRCP protocol provided.

Findings:

Liver: Unremarkable without evidence of ductal dilatation or focal mass. No signal drop on the out-of-phase images to suggest hepatic steatosis. 5.9 inches craniocaudally.

Gallbladder or biliary duct: No cholelithiasis. The common duct measures 3 mm maximally. No visualized common duct stone. Increased infolding at the fundus, likely adenomyomatosis.

Spleen: Normal. 3.26 inches.

Pancreas: No pancreatic divisum. No main pancreatic duct dilatation. No focal mass or abnormal enhancement. No surrounding edema.

Adrenal glands: Normal.

Please suggest on information provided above along with scan reports. I am taking Zyrtec, Zoloft, Omeprazole, Singulair, and Lovastatin medicines.

Thank you.

Hello doctor,

Thank you for your answers. I have a few more questions.

1. Since I had this fundal adenomyomatosis two years ago, does that make it more likely that what the radiologist is seeing on the ultrasound is adenomyomatosis again?

2. What does “likely” adenomyomatosis mean in terms of percent of certainty? Could it be cancer?

3. Is 1 cm alarmingly large?

I am very anxious because I read about the very poor survival rates of gallbladder cancer.

Please suggest.

Hello doctor,

My gastroenterologist has referred me to a surgeon. I am nervous. I had a CT scan last week. I am assuming my lymph nodes looked normal, as they were not mentioned.

Please suggest.