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'''Gallbladder adenoma''' is a pre-malignant lesion of the [[gallbladder]]. | |||
''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: | |||
*Low grade dysplasia should prompt targeted sampling and review.<ref name=uscap2017_akki/> | |||
*Gallbladders with high grade dysplasia should be [[submitted in total]] to exclude [[gallbladder adenocarcinoma]].<ref name=uscap2017_akki>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 http://www.abstracts2view.com/uscap17/view.php?nu=USCAP17L_2016]. United States and Canadian Academy of Pathology Annual Meeting. Accessed on: April 9, 2017.</ref><ref name=pmid33629395/> | |||
DDx: | |||
*[[Gallbladder adenocarcinoma]]. | |||
*Reactive changes. | |||
===Grading dysplasia=== | |||
Low grade dysplasia:<ref name=pmid33629395>{{cite journal |authors=Roa JC, Basturk O, Adsay V |title=Dysplasia and carcinoma of the gallbladder: pathological evaluation, sampling, differential diagnosis and clinical implications |journal=Histopathology |volume=79 |issue=1 |pages=2–19 |date=July 2021 |pmid=33629395 |doi=10.1111/his.14360 |url=}}</ref> | |||
*Surface epithelium changes: hyperchromasia, pseudostratification, elongated nuclei; nuclei stratified/confined mainly to lower aspect of the epithelium. | |||
High grade dysplasia:<ref name=pmid33629395/> | |||
*Diffuse and severe (cytologic) atypia: nuclei no long stratified. | |||
===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== | |||
<pre> | |||
GALLBLADDER, CHOLECYSTECTOMY: | |||
- BILIARY TYPE TUBULAR ADENOMA WITH HIGH GRADE DYSPLASIA. | |||
- MARGINS CLEAR OF ADENOMA (NEAREST MARGIN 1.0 CM). | |||
</pre> | |||
==See also== | |||
*[[Gallbladder]]. | |||
*[[Intestinal metaplasia of the gallbladder]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Gastrointestinal pathology]] | |||