Intestinal metaplasia of the gallbladder

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Intestinal metaplasia of the gallbladder is a pathology of the gallbladder associated with an increased risk of gallbladder carcinoma.

Intestinal metaplasia of the gallbladder
Diagnosis in short

Gallbladder with intestinal metaplasia. H&E stain.
LM gallbladder mucosa with goblet cells +/-Paneth cells
LM DDx gallbladder dysplasia, gallbladder carcinoma
Stains Alcian blue stain +ve
Grossing notes Gallbladder grossing
Site gallbladder
Associated Dx chronic cholecystitis
Prognosis benign, increased risk of carcinoma

It is also known as gallbladder intestinal metaplasia.

General

Significance:

  • Increased risk of carcinoma.[2]

Gross

  • No specific changes.

Notes:

  • Usually seen in the context of chronic cholecystitis if isolated.

Microscopic

Features:[3]

Notes:

  • Often accompanied by antral type metplasia.
    • Gastric antral-type epithelium - may form glands.
  • Gallbladders with intestinal metaplasia do not have to be submitted in total.[5]
    • Adsay et al. suggest submitting two additional cassettes of tissue.[6]

DDx:

Images

  • GB with IM - low mag.

  • GB with IM - intermed. mag.

  • GB with IM - high mag.

www:

Stains

  • Alcian blue/PAS +ve.

Sign out

Gallbladder, Cholecystectomy: 
	- Gallbladder wall with focal intestinal metaplasia and mild chronic inflammation.
	- Cholelithiasis.
	- NEGATIVE for dysplasia.

Block letters

GALLBLADDER, CHOLECYSTECTOMY: 
- INTESTINAL METAPLASIA OF THE GALLBLADDER, FOCAL. 
- CHRONIC CHOLECYSTITIS. 
- CHOLELITHIASIS.
- NEGATIVE FOR DYSPLASIA.

Micro

The sections show gallbladder wall with mild chronic inflammation and entrapped epithelial crypts, that focally extend through the muscularis. The entrapped deep crypts have no apparent nuclear atypia, and no apparent mitotic activity.

A very small focus of intestinal metaplasia is present in the surface epithelium. No dysplasia is identified.

See also

References

  1. ↑ Sai, K.; Kajiwara, H. (2001). "An immunohistochemical study of metaplastic endocrine cells in human gallbladder cancer.". J Hepatobiliary Pancreat Surg 8 (5): 453-60. PMID 11702256.
  2. ↑ Duarte, I.; Llanos, O.; Domke, H.; Harz, C.; Valdivieso, V. (Sep 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.
  3. ↑ Albores-Saavedra, J.; Nadji, M.; Henson, DE.; Ziegels-Weissman, J.; Mones, JM. (Jun 1986). "Intestinal metaplasia of the gallbladder: a morphologic and immunocytochemical study.". Hum Pathol 17 (6): 614-20. PMID 2872152.
  4. ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 1789. ISBN 978-0781740517.
  5. ↑ Akki et al. (2017) "Detecting Incidental Gallbladder Adenocarcinoma: When to Submit the Entire Gallbladder". Available at: http://www.abstracts2view.com/uscap17/view.php?nu=USCAP17L_2016. United States and Canadian Academy of Pathology Annual Meeting. Accessed on: April 9, 2017.
  6. ↑ "Criteria for pathologic sampling of gallbladder specimens". Am J Clin Pathol 140 (2): 278–80. August 2013. doi:10.1309/AJCPUJPGQIZ6DC6A. PMID 23897266.
  7. ↑ Mukhopadhyay, S.; Landas, SK. (Mar 2005). "Putative precursors of gallbladder dysplasia: a review of 400 routinely resected specimens.". Arch Pathol Lab Med 129 (3): 386-90. doi:10.1043/1543-2165(2005)129386:PPOGDA2.0.CO;2. PMID 15737036.
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