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The '''gallbladder''', in pathology (and '''general surgery'''), is a growth industry... due to the worsening obesity epidemic. | The '''gallbladder''', in pathology (and '''general surgery'''), is a growth industry... due to the worsening [[obesity]] epidemic. | ||
=Normal | =Normal= | ||
==Anatomy== | |||
*Body. | |||
*Fundus. | |||
*Neck. | |||
Variations: | |||
*Hartmann's pouch - invagination of the gallbladder wall at the origin of the cystic duct. | |||
Image: | |||
*[http://web.uni-plovdiv.bg/stu1104541018/docs/res/skandalakis'%20surgical%20anatomy%20-%202004/Chapter%2020_%20Extrahepatic%20Biliary%20Tract%20and%20Gallbladder_fichiers/loadBinaryCAS7X571.jpg Hartmann's pouch (uni-plovdiv.bg)].<ref>URL: [http://web.uni-plovdiv.bg/stu1104541018/docs/res/skandalakis'%20surgical%20anatomy%20-%202004/Chapter%2020_%20Extrahepatic%20Biliary%20Tract%20and%20Gallbladder.htm http://web.uni-plovdiv.bg/stu1104541018/docs/res/skandalakis'%20surgical%20anatomy%20-%202004/Chapter%2020_%20Extrahepatic%20Biliary%20Tract%20and%20Gallbladder.htm]. Accessed on: 13 December 2012.</ref> | |||
==Histology== | |||
*'''No''' muscularis mucosae. | *'''No''' muscularis mucosae. | ||
*Small amount of lymphocytes in the lamina propria. | *Small amount of lymphocytes in the lamina propria. | ||
Note: | Note: | ||
*As there is no ''muscularis mucosae'', the [[cancer staging]] is different; pT1a is lamina propria invasion. pT1b is muscle layer invasion. | *As there is no ''muscularis mucosae'', the [[cancer staging]] is different; pT1a is lamina propria invasion. pT1b is muscle layer invasion. | ||
===Image=== | |||
<gallery> | |||
Image:Gallbladder_-_intermed_mag.jpg | Normal gallbladder - intermed. mag. (WC/Nephron) | |||
</gallery> | |||
=Overview= | =Overview= | ||
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=Common= | =Common= | ||
==Chronic cholecystitis== | ==Chronic cholecystitis== | ||
{{Main|Chronic cholecystitis}} | |||
==Acute cholecystitis== | ==Acute cholecystitis== | ||
{{Main|Acute cholecystitis}} | |||
==Gallbladder cholesterolosis== | ==Gallbladder cholesterolosis== | ||
{{Main|Gallbladder cholesterolosis}} | |||
==Cholelithiasis== | ==Cholelithiasis== | ||
*[[AKA]] ''gallstones''. | *[[AKA]] ''gallstones''. | ||
{{Main|Cholelithiasis}} | |||
=Less common pathologic diagnoses= | =Less common pathologic diagnoses= | ||
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*[[AKA]] ''gallbladder adenomyosis''. | *[[AKA]] ''gallbladder adenomyosis''. | ||
*[[AKA]] ''adenomyomatosis of the gallbladder''. | *[[AKA]] ''adenomyomatosis of the gallbladder''. | ||
*[[AKA]] ''gallbladder adenomyoma''. | |||
===General=== | ===General=== | ||
*Glands in muscle. | *Glands in muscle. | ||
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features:<ref name=Ref_GLP439>{{Ref GLP|439}}</ref> | ||
*Glands in muscularis propria of the gallbladder wall. | *Glands in muscularis propria of the gallbladder wall - '''key feature'''. | ||
*Significant muscular hypertrophy - '''key feature'''. | |||
*No nuclear atypia. | *No nuclear atypia. | ||
DDx: | DDx: | ||
*[[Gallbladder carcinoma]]. | *[[Gallbladder carcinoma]]. | ||
*[[Chronic cholecystitis]] - has less muscular hypertrophy; overlaps with this diagnosis.<ref name=Ref_GLP439>{{Ref GLP|439}}</ref> | |||
*Phrygian cap.<reF>URL: [http://radiopaedia.org/articles/phrygian_cap http://radiopaedia.org/articles/phrygian_cap]. Accessed on: 16 May 2014.</ref> | |||
Image | ====Image==== | ||
*[http:// | *[http://pubs.rsna.org/na101/home/literatum/publisher/rsna/journals/content/radiographics/2006/radiographics.2006.26.issue-3/rg.263055180/production/images/medium/g06ma19c05x.jpeg Adenomyomatosis of the gallbladder (radiographics.rsna.org)].<ref name=pmid16702464/> | ||
===Sign out=== | |||
<pre> | |||
GALLBLADDER, CHOLECYSTECTOMY: | |||
- CHRONIC CHOLECYSTITIS WITH MILD CHOLESTEROLOSIS AND ADENOMYOSIS (FUNDUS). | |||
- CHOLELITHIASIS. | |||
</pre> | |||
==Gallbladder polyps== | ==Gallbladder polyps== | ||
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**Hyperchromasia (essential). | **Hyperchromasia (essential). | ||
**+/-Intestinal metaplasia --> goblet cells. | **+/-Intestinal metaplasia --> goblet cells. | ||
==Gallbladder diverticulosis== | |||
===General=== | |||
*Uncommon. | |||
*Thought to arise in the context of an outflow obstruction.<ref name=pmid4963758>{{Cite journal | last1 = Beilby | first1 = JO. | title = Diverticulosis of the gall bladder. The fundal adenoma. | journal = Br J Exp Pathol | volume = 48 | issue = 4 | pages = 455-61 | month = Aug | year = 1967 | doi = | PMID = 4963758 | PMC = 2093791 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2093791/}}</ref> | |||
===Microscopic=== | |||
Features: | |||
*Mucosal pouch penetrating the muscularis propria of the gallbladder wall - '''key feature'''. | |||
DDx: | |||
*[[Chronic cholecystitis]]. | |||
*[[Gallbladder adenomyosis]]. | |||
===Sign out=== | |||
<pre> | |||
GALLBLADDER, CHOLECYSTECTOMY: | |||
- CHRONIC CHOLECYSTITIS WITH DIVERTICULOSIS. | |||
- CHOLELITHIASIS. | |||
</pre> | |||
==Xanthogranulomatous cholecystitis== | |||
*Abbreviated ''XGC''. | |||
{{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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*Antral type metaplasia --> intestinal metaplasia --> dysplasia --> carcinoma. | *Antral type metaplasia --> intestinal metaplasia --> dysplasia --> carcinoma. | ||
==Intestinal metaplasia | ==Intestinal metaplasia of the gallbladder== | ||
*[[AKA]] ''gallbladder [[intestinal metaplasia]]''. | |||
{{Main|Intestinal metaplasia of the gallbladder}} | |||
* | |||
==Antral type metaplasia== | ==Antral type metaplasia== | ||
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Notes: | Notes: | ||
*May look similar to cells of the gallbladder neck<ref name=Ref_Sternberg4_1789>{{Ref Sternberg4|1789}}</ref> and common bile duct.<ref> | *May look similar to cells of the gallbladder neck<ref name=Ref_Sternberg4_1789>{{Ref Sternberg4|1789}}</ref> and common bile duct.<ref>Cutz, E. 3 March 2011.</ref> | ||
**These glandular cells are not as columnar and have less well-defined cell borders. | **These glandular cells are not as columnar and have less well-defined cell borders. | ||
***Cells with antral type metaplasia >2:1 (height:width), benign mucosal glands <2:1. | ***Cells with antral type metaplasia >2:1 (height:width), benign mucosal glands <2:1. | ||
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*[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> | ||
== | ===Sign out=== | ||
<pre> | |||
Gallbladder, Cholecystectomy: | |||
- Chronic cholecystitis with antral-type metaplasia, NEGATIVE for dysplasia. | |||
- Cholelithiasis. | |||
</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 }} | |||
</ref>== | |||
===General=== | ===General=== | ||
*Probably some overlap with 'adenoma' above | |||
* | *Lesion defined as being >1cm. | ||
* | *Low-grade lesions previously designated “papillary adenoma” | ||
* | *High-grade lesions previously designated “noninvasive papillary carcinoma.” | ||
* | *Oten arise in a background of pyloric-gland metaplasia. | ||
*May be associated with invasive adenocarcinoma, which should be reported as intracystic papillary neoplasm with an associated invasive carcinoma and staged. | |||
*Population | |||
* | **Female (F/M=2:1) | ||
** | **Mean age 61 | ||
* | *Presentations | ||
**Pain | |||
**Incidental | |||
*No particular association with gallstones. | |||
=== | ===Microscopic=== | ||
* | *Cell types | ||
**Pancreatobiliary type | |||
**Intestinal types with goblet, Paneth, and/or serotonin-containing cells. | |||
*Architecture | |||
**Papillary | |||
**Tubulopapillary | |||
**Tubular | |||
*Dysplasia - high or low grade | |||
Image: | <gallery> | ||
Image:GallBladder IntracysticPapillaryNeoplasm WA InvasiveAdenocarcinoma LP CTR.jpg|Gall Bladder - Intracholecystic Papillary Neoplasm with Invasive Adenocarcinoma - Low power (SKB) | |||
Image:GallBladder IntracysticPapillaryNeoplasm WA InvasiveAdenocarcinoma HP CTR.jpg|Gall Bladder - Intracholecystic Papillary Neoplasm with Invasive Adenocarcinoma - High power (SKB) | |||
Image:GallBladder IntracysticPapillaryNeoplasm WA InvasiveAdenocarcinoma HP3 CTR.jpg|Gall Bladder - Intracholecystic Papillary Neoplasm with Invasive Adenocarcinoma - High power (SKB) | |||
Image:GallBladder IntracysticPapillaryNeoplasm WA InvasiveAdenocarcinoma HP2 CTR.jpg|Gall Bladder - Intracholecystic Papillary Neoplasm with Invasive Adenocarcinoma - High power (SKB) | |||
Image:GallBladder IntracysticPapillaryNeoplasm WA InvasiveAdenocarcinoma MP CTR.jpg|Gall Bladder - - Intracholecystic Papillary Neoplasm with Invasive Adenocarcinoma - Malignant gland infiltrating stroma - High power (SKB) | |||
Image:GallBladder IntracysticPapillaryNeoplasm WA InvasiveAdenocarcinoma HP4 CTR.jpg|Gall Bladder - Intracholecystic Papillary Neoplasm with Invasive Adenocarcinoma - - Malignant gland infiltrating stroma - Very high power (SKB) | |||
Image:Gallbladder IntracysticPapillaryNeoplasm HighGradeDysplasia LP PA.JPG|Gall Bladder - Intracholecystic Papillary Neoplasm with high grade dysplasia - Low power (SKB) | |||
Image:Gallbladder IntracysticPapillaryNeoplasm HighGradeDysplasia MP PA.JPG|Gall Bladder - Intracholecystic Papillary Neoplasm with high grade dysplasia - Medium power (SKB) | |||
</gallery> | |||
Notes: | Notes: | ||
All of the gallbladder should be submitted prior to sign out to exclude invasive adenocarcinoma. | |||
=Malignant= | |||
==Gallbladder carcinoma== | |||
{{Main|Gallbladder carcinoma}} | |||
=See also= | =See also= | ||
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{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gallbladder]] | |||
[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] |
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