Difference between revisions of "Gallbladder"
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==Dysplasia== | ==Dysplasia== | ||
*Premalignant lesion. | |||
*Like colon | |||
===Microscopic=== | |||
Features: | |||
*Nuclear crowding. | |||
*Nuclear hyperchromasia. | |||
Notes: | |||
*Like in the colon. | |||
==Carcinoma== | ==Carcinoma== | ||
Revision as of 19:21, 25 May 2010
The gallbladder, in pathology (and general surgery), is a growth industry... due to the worsening obesity epidemic.
Normal
Histology
- NO muscularis mucosae.
- Small amount of lymphocytes in the lamina propria.
Pathology
Most common:
- Cholelithiasis with cholecystitis.
Cholecystitis
Epidemiology
- Female, fat, fertile, family history, forty (though now getting younger... as people get fatter).
Etiology
- Cholelithiasis.
- Thick bile (acalculous cholecystitis).
Clinical (classic)
- Constant right upper quadrant pain after a fatty meal.
- Positive Murphy's sign (physical exam, with ultrasound).
Gross
- Strawberry-like appearance - common (due to cholesterolosis -- see below)
- Small ridges (microvillus architecture).
- Normal gallbladder mucosa = smooth.
- Small ridges (microvillus architecture).
- Congestion/erythema.
Microscopic
- Rokitansky-Aschoff sinuses[1]
- Entrapped epithelial crypts -- pockets of epithelium in the wall of the gallbladder.
- +/-Foamy macrophages in the lamina propria.
- Inflammatory cells.
- Neutrophils are not essential for the Dx - usually secondary to necrosis/ulceration or infection.[2]
Cholesterolosis
General
- Common in cholecystitis.
- Assoc. with yellow gallstones (cholesterol type gallstones).
Gross
- Mucsoa has strawberry-like appearance.
Microscopic
- Foamy macrophages.
Image:
- Cholesterolosis (micrograph) - wikipedia.org.
Cholelithiasis
- Often accompanies cholecystitis/contributes and/or causes cholecystitis
The two types of gallstones:
- Cholesterol stones
- More common than pigment stone.
- Appearance:
- Clear or yellow.
- Opaque or translucent.
- Sometimes shinny.
- Pigment stones
- Due to high RBC turnover, e.g. sickle cell anemia, thalassemia.
- Appearance:
- Black - key feature.
- Dull.
Note: Most stones are a mix technically speaking, i.e. cholesterol and pigment. Many call yellow stones that are often a mix "cholesterol stones".
Crystalline gallstones -- UC association (?):[3]
Less common pathologic diagnoses
Adenomyosis
General
- Glands in muscle.
- Analogous to what happens in the uterus.
- Significance??? -- consequence of long standing cholecystitis/Rokitansky-Aschoff sinuses???
Histology
- Glands in muscularis propria of the gallbladder wall.
Gangrenous gallbladder
- Necrosis of gallbladder wall (muscularis propria).[4]
Polyps
- Polyps - significant as they may be adenomatous, i.e. pre-cancerous.
Flat dysplasia[5]
- Nuclear changes
- Incr. NC ratio,
- Hyperchromasia (essential),
- +/-Intestinal metaplasia --> goblet cells.
Premalignant lesions - metaplasia/dysplasia
- Metaplasia assoc. with carcinoma.[6]
Hypothesis:[7]
- Antral type metaplasia --> intestinal metaplasia --> dysplasia --> carcinoma.
Intestinal metaplasia
Definition:
- Presence of goblet cells -/+ paneth cells[8]
Significance:
- Increased risk of carcinoma.[6]
Antral type metaplasia
General
Micro.
- Cells with...[10]
- Abundant, pale, apical mucin.
- Small basal nucleus.
- Cells often in nests -- below luminal surface.
- Cells vaguely resemble foveollar epithelium of the stomach.
Dysplasia
- Premalignant lesion.
Microscopic
Features:
- Nuclear crowding.
- Nuclear hyperchromasia.
Notes:
- Like in the colon.
Carcinoma
Epidemiology
- Associated with gallstones.
- Sex: female > male.
- Location: usually fundus, sometimes body.
Notes:
- Calcification of gallbladder wall aka "Porcelain gallbladder" -- not associated with carcinoma.[11]
- Cholangiocarcinoma is dealt with in the liver neoplasms article.
Microscopic
- Usually adenocarcinoma.
- Mimics appearance of pancreatic ductal adenocarcinoma-- but less cellular mucin.[12]
See also
References
- ↑ http://www.whonamedit.com/synd.cfm/983.html
- ↑ DCHHP P.174
- ↑ http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1358536
- ↑ STC 25 Feb 2009.
- ↑ DCHHP P.172
- ↑ 6.0 6.1 Duarte I, Llanos O, Domke H, Harz C, Valdivieso V (September 1993). "Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples". Cancer 72 (6): 1878–84. PMID 8364865.
- ↑ Mukhopadhyay S, Landas SK (March 2005). "Putative precursors of gallbladder dysplasia: a review of 400 routinely resected specimens". Arch. Pathol. Lab. Med. 129 (3): 386–90. PMID 15737036. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=129&page=386.
- ↑ Sternberg DSP4 P.1789
- ↑ Sternberg DSP4 P.1789
- ↑ Sternberg DSP4 P.1789
- ↑ Towfigh S, McFadden DW, Cortina GR, et al (January 2001). "Porcelain gallbladder is not associated with gallbladder carcinoma". Am Surg 67 (1): 7?0. PMID 11206901.
- ↑ DCHHP P.174