POLYPOID ADENOMYOMA OF THE GALLBLADDER

We describe a distinctive polypoid lesion of the gallbladder (16 mm in diameter) at the fundus, associated with a granulomatous mass in the liver adjacent to the gallbladder fossa, in a 64-year-old Japanese wom an. Preoperatively, the lesion was diagnosed as advanced gallbladder c ancer infiltrating the liver, and hepatopancreato-duodenectomy was per formed. In the resected specimen, the polyp was round and pedunculate in shape, and, microscopically, it consisted of a mixture of small gla ndular and surrounding muscular elements, but atypia was not noted. Th e constituent elements were identical with those of adenomyoma, but th e polypoid appearance was unusual. The hepatic lesion proved to be a f oreign body granuloma containing multiple barium fragments and giant c ells. A deep gastric ulcer, which penetrated into the gallbladder foss a, was also noted, near the granuloma. The histologic features indicat e that the polypoid appearance of the tumor was due to a secondary mod ification of pre-existing adenomyoma by hepatic granuloma. To our know ledge, this is the second reported case of an adenomyomatous lesion of the gallbladder with a polypoid appearance.