Difference between revisions of "Gallbladder"

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==Cholelithiasis==
==Cholelithiasis==
*[[AKA]] ''gallstones''.
*[[AKA]] ''gallstones''.
===General===
{{Main|Cholelithiasis}}
*Often accompanies [[cholecystitis]]/contributes and/or causes cholecystitis.
*The gallbladder is removed following ''biliary pancreatitis'' ([[gallstone pancreatitis]]) to reduce recurrence risk.<ref name=pmid23181667>{{Cite journal  | last1 = Bouwense | first1 = SA. | last2 = Besselink | first2 = MG. | last3 = van Brunschot | first3 = S. | last4 = Bakker | first4 = OJ. | last5 = van Santvoort | first5 = HC. | last6 = Schepers | first6 = NJ. | last7 = Boermeester | first7 = MA. | last8 = Bollen | first8 = TL. | last9 = Bosscha | first9 = K. | title = Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial. | journal = Trials | volume = 13 | issue =  | pages = 225 | month =  | year = 2012 | doi = 10.1186/1745-6215-13-225 | PMID = 23181667 }}</ref><ref name=pmid22470079>{{Cite journal  | last1 = van Baal | first1 = MC. | last2 = Besselink | first2 = MG. | last3 = Bakker | first3 = OJ. | last4 = van Santvoort | first4 = HC. | last5 = Schaapherder | first5 = AF. | last6 = Nieuwenhuijs | first6 = VB. | last7 = Gooszen | first7 = HG. | last8 = van Ramshorst | first8 = B. | last9 = Boerma | first9 = D. | title = Timing of cholecystectomy after mild biliary pancreatitis: a systematic review. | journal = Ann Surg | volume = 255 | issue = 5 | pages = 860-6 | month = May | year = 2012 | doi = 10.1097/SLA.0b013e3182507646 | PMID = 22470079 }}</ref>
*Gallstones may compress the common bile duct - known as ''Mirizzi Syndrome''.<ref name=pmid25672201>{{Cite journal  | last1 = Khalid | first1 = S. | last2 = Bhatti | first2 = AA. | title = Mirizzi's syndrome: an interesting on table finding. | journal = J Ayub Med Coll Abbottabad | volume = 26 | issue = 4 | pages = 621-4 | month =  | year =  | doi =  | PMID = 25672201 }}</ref>
**Can be associated with jaundice.<ref name=pmid25513064>{{Cite journal  | last1 = Elhanafy | first1 = E. | last2 = Atef | first2 = E. | last3 = El Nakeeb | first3 = A. | last4 = Hamdy | first4 = E. | last5 = Elhemaly | first5 = M. | last6 = Sultan | first6 = AM. | title = Mirizzi Syndrome: How it could be a challenge. | journal = Hepatogastroenterology | volume = 61 | issue = 133 | pages = 1182-6 | month =  | year =  | doi =  | PMID = 25513064 }}</ref>
 
The two types of gallstones:
*Cholesterol stones.
*Pigment stones.
 
Note:
*Most stones technically speaking are a mix, i.e. cholesterol and pigment.  Many call yellow stones that are a mix "cholesterol stones".
 
====Epidemiology====
Classic risk factors for gallstones - 4 Fs:<ref name=pmid18540184>{{Cite journal  | last1 = Szwed | first1 = Z. | last2 = Zyciński | first2 = P. | title = [4F's--still up to date risk factors of cholelithiasis]. | journal = Wiad Lek | volume = 60 | issue = 11-12 | pages = 570-3 | month =  | year = 2007 | doi =  | PMID = 18540184 }}</ref>
*'''F'''emale.
*'''F'''at.
*'''F'''orty.
*'''F'''ertile.
 
Additional:
*Family history.
 
====Cholesterol stones====
*More common than pigment stone.
 
Appearance:
*Clear or yellow.
*Opaque or translucent.
*Sometimes shinny.
 
=====Image=====
<gallery>
Image:Gallensteine_2006_03_28.JPG | Yellow gallstones. (WC)
</gallery>
====Pigment stones====
*Due to high [[RBC]] turnover, e.g. [[sickle cell disease]], thalassemia.
*Radio-opaque.<ref>URL: [http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20%28General%20Monographs-%20U%29/URSOFALK.html http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20%28General%20Monographs-%20U%29/URSOFALK.html]. Accessed on: 29 October 2011.</ref>
 
Appearance:
*Black - '''key feature'''.
*Dull.
 
===Microscopic===
*Not routinely done on gallstones.
 
===Sign out===
<pre>
GALLBLADDER CHOLECYSTECTOMY:
- CHOLELITHIASIS.
- MILD CHRONIC CHOLECYSTITIS.
</pre>


=Less common pathologic diagnoses=
=Less common pathologic diagnoses=
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*Abbreviated ''XGC''.
*Abbreviated ''XGC''.
{{Main|Xanthogranulomatous cholecystitis}}
{{Main|Xanthogranulomatous cholecystitis}}
==Pancreatic heterotopia==
[[File:Gallbladder mass benign A sl 1.png|Pancreatic heterotopia in 35 year old women]]
[[File:Gallbladder mass benign A sl 2.png|Pancreatic heterotopia in 35 year old women]]
[[File:Gallbladder mass benign A sl 3.png|Pancreatic heterotopia in 35 year old women]]
[[File:Gallbladder mass benign A sl 4.png|Pancreatic heterotopia in 35 year old women]]<br>
Pancreatic heterotopia near cystic duct in 35 year old women. A. The cystic duct margin is at right; the heterotopia, at left. This cannot be a portion of the pancreas because the cystic duct margin lies proximal to the common bile duct. B. Pancreatic ducts with lobular proliferation, but without the inflammation that would usually be present were this obstruction by a gallstone. C. Nuclei of the duct and the proliferated bile ductules are bland. D. Acini are unremarkable; no pancreatic islets were seen in this case.


=Premalignant lesions=
=Premalignant lesions=
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Images:
Images:
*[http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282005%29129%3C386%3APPOGDA%3E2.0.CO%3B2 Gallbladder metaplasias (archivesofpathology.org)].<ref name=pmid15737036>{{cite journal |author=Mukhopadhyay S, Landas SK |title=Putative precursors of gallbladder dysplasia: a review of 400 routinely resected specimens |journal=Arch. Pathol. Lab. Med. |volume=129 |issue=3 |pages=386–90 |year=2005 |month=March |pmid=15737036 |doi= |url=http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282005%29129%3C386%3APPOGDA%3E2.0.CO%3B2 }}</ref>
*[http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282005%29129%3C386%3APPOGDA%3E2.0.CO%3B2 Gallbladder metaplasias (archivesofpathology.org)].<ref name=pmid15737036>{{cite journal |author=Mukhopadhyay S, Landas SK |title=Putative precursors of gallbladder dysplasia: a review of 400 routinely resected specimens |journal=Arch. Pathol. Lab. Med. |volume=129 |issue=3 |pages=386–90 |year=2005 |month=March |pmid=15737036 |doi= |url=http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282005%29129%3C386%3APPOGDA%3E2.0.CO%3B2 }}</ref>
==Gallbladder adenoma==
:''Gallbladder dysplasia'' redirects here.
===General===
*Premalignant lesion.
*May be associated with [[familial adenomatous polyposis]] or [[Peutz-Jeghers syndrome]].<ref name=pmid11896229>{{Cite journal  | last1 = Levy | first1 = AD. | last2 = Murakata | first2 = LA. | last3 = Abbott | first3 = RM. | last4 = Rohrmann | first4 = CA. | title = From the archives of the AFIP. Benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: radiologic-pathologic correlation. Armed Forces Institute of Pathology. | journal = Radiographics | volume = 22 | issue = 2 | pages = 387-413 | month =  | year =  | doi =  | PMID = 11896229 | url = http://radiographics.rsna.org/content/22/2/387.full }}</ref>
===Microscopic===
Features:
*Gallbladder epithelium with:
**Nuclear atypia - '''key feature'''.
***Nuclear hyperchromasia.
***Nuclear crowding (pseudostratification) ''or'' round enlarged nuclei.
**+/-Goblet cells.
Architectural subclassification:<ref name=pmid22895264>{{Cite journal  | last1 = Adsay | first1 = V. | last2 = Jang | first2 = KT. | last3 = Roa | first3 = JC. | last4 = Dursun | first4 = N. | last5 = Ohike | first5 = N. | last6 = Bagci | first6 = P. | last7 = Basturk | first7 = O. | last8 = Bandyopadhyay | first8 = S. | last9 = Cheng | first9 = JD. | title = Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases. | journal = Am J Surg Pathol | volume = 36 | issue = 9 | pages = 1279-301 | month = Sep | year = 2012 | doi = 10.1097/PAS.0b013e318262787c | PMID = 22895264 }}</ref>
*Papillary ~ 45%.
*Tubulopapillary ~ 30%.
*Tubular ~ 25%.
Notes:
*All of the gallbladder should be submitted prior to sign out to exclude non-sampled adenocarcinoma.
DDx:
*[[Gallbladder adenocarcinoma]].
*Reactive changes.
====Images====
*[http://radiographics.rsna.org/content/22/2/387/F4.expansion.html Tubular adenoma, biliary type (rsna.org)].<ref name=pmid11896229/>
*[http://www.flickr.com/photos/lunarcaustic/4986649333/ Gallbladder with high-grade dysplasia (flickr.com/lunar caustic)].


===Sign out===
===Sign out===
<pre>
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
Gallbladder, Cholecystectomy:
- BILIARY TYPE TUBULAR ADENOMA WITH HIGH GRADE DYSPLASIA.
- Chronic cholecystitis with antral-type metaplasia, NEGATIVE for dysplasia.
- MARGINS CLEAR OF ADENOMA (NEAREST MARGIN 1.0 CM).
- Cholelithiasis.
</pre>
</pre>
==Gallbladder adenoma==
:''Gallbladder dysplasia'' is covered in ''[[gallbladder adenoma]]''.
{{Main|Gallbladder adenoma}}


==Intracholecystic Papillary Neoplasm<ref>{{Cite journal  | last1 = Adsay | first1 = V. | last2 = Jang | first2 = KT. | last3 = Roa | first3 = JC. | last4 = Dursun | first4 = N. | last5 = Ohike | first5 = N. | last6 = Bagci | first6 = P. | last7 = Basturk | first7 = O. | last8 = Bandyopadhyay | first8 = S. | last9 = Cheng | first9 = JD. | title = Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases. | journal = Am J Surg Pathol | volume = 36 | issue = 9 | pages = 1279-301 | month = Sep | year = 2012 | doi = 10.1097/PAS.0b013e318262787c | PMID = 22895264 }}
==Intracholecystic Papillary Neoplasm<ref>{{Cite journal  | last1 = Adsay | first1 = V. | last2 = Jang | first2 = KT. | last3 = Roa | first3 = JC. | last4 = Dursun | first4 = N. | last5 = Ohike | first5 = N. | last6 = Bagci | first6 = P. | last7 = Basturk | first7 = O. | last8 = Bandyopadhyay | first8 = S. | last9 = Cheng | first9 = JD. | title = Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases. | journal = Am J Surg Pathol | volume = 36 | issue = 9 | pages = 1279-301 | month = Sep | year = 2012 | doi = 10.1097/PAS.0b013e318262787c | PMID = 22895264 }}
Michael
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