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Difference between revisions of "Gallbladder"
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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 histology= | |||
*NO muscularis mucosae. | *NO muscularis mucosae. | ||
*Small amount of lymphocytes in the lamina propria. | *Small amount of lymphocytes in the lamina propria. | ||
= | =Overview= | ||
Most common: | Most common: | ||
*Cholelithiasis with cholecystitis. | *Cholelithiasis with cholecystitis. | ||
Common: | |||
*Antral-type metaplasia. | |||
Uncommon: | |||
*Intestinal metaplasia. | |||
*Gallbladder dysplasia. | |||
*Gallbladder carcinoma. | |||
=Common= | |||
==Cholecystitis== | ==Cholecystitis== | ||
===Epidemiology=== | ===General=== | ||
====Epidemiology==== | |||
*Female, fat, fertile, family history, forty (though now getting younger... as people get fatter). | *Female, fat, fertile, family history, forty (though now getting younger... as people get fatter). | ||
===Etiology=== | ====Etiology==== | ||
*Cholelithiasis. | *Cholelithiasis. | ||
*Thick bile (acalculous cholecystitis). | *Thick bile (acalculous cholecystitis). | ||
===Clinical (classic)=== | ====Clinical (classic)==== | ||
*Constant right upper quadrant pain after a fatty meal. | *Constant right upper quadrant pain after a fatty meal. | ||
*Positive Murphy's sign (physical exam, with ultrasound). | *Positive Murphy's sign (physical exam, with ultrasound). | ||
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===Microscopic=== | ===Microscopic=== | ||
*Rokitansky-Aschoff sinuses<ref>[http://www.whonamedit.com/synd.cfm/983.html http://www.whonamedit.com/synd.cfm/983.html]</ref> | Features: | ||
*Rokitansky-Aschoff sinuses.<ref>[http://www.whonamedit.com/synd.cfm/983.html http://www.whonamedit.com/synd.cfm/983.html]</ref> | |||
**Entrapped epithelial crypts -- pockets of epithelium in the wall of the gallbladder. | **Entrapped epithelial crypts -- pockets of epithelium in the wall of the gallbladder. | ||
*+/-Foamy macrophages in the lamina propria. | *+/-Foamy macrophages in the lamina propria. | ||
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Crystalline gallstones -- UC association (?):<ref>http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1358536</ref> | Crystalline gallstones -- UC association (?):<ref>http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1358536</ref> | ||
=Less common pathologic diagnoses= | |||
==Adenomyosis== | ==Adenomyosis== | ||
===General=== | ===General=== | ||
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*Significance??? -- consequence of long standing cholecystitis/Rokitansky-Aschoff sinuses??? | *Significance??? -- consequence of long standing cholecystitis/Rokitansky-Aschoff sinuses??? | ||
=== | ===Microscopic=== | ||
Features: | |||
*Glands in muscularis propria of the gallbladder wall. | *Glands in muscularis propria of the gallbladder wall. | ||
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**+/-Intestinal metaplasia --> goblet cells. | **+/-Intestinal metaplasia --> goblet cells. | ||
=Premalignant lesions - metaplasia/dysplasia= | |||
*Metaplasia | *Metaplasia associated with carcinoma.<ref name=pmid8364865>{{cite journal |author=Duarte I, Llanos O, Domke H, Harz C, Valdivieso V |title=Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples |journal=Cancer |volume=72 |issue=6 |pages=1878–84 |year=1993 |month=September |pmid=8364865 |doi= |url=}}</ref> | ||
Hypothesis:<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> | Hypothesis:<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> | ||
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==Intestinal metaplasia== | ==Intestinal metaplasia== | ||
===General=== | |||
Significance: | Significance: | ||
*Increased risk of carcinoma.<ref name=pmid8364865/> | *Increased risk of carcinoma.<ref name=pmid8364865/> | ||
===Microscopic=== | |||
Features: | |||
*Presence of [[goblet cell]]s -/+ paneth cells.<ref name=Ref_Sternberg4_1789>{{Ref Sternberg4|1789}}</ref> | |||
==Antral type metaplasia== | ==Antral type metaplasia== | ||
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*Like in the colon. | *Like in the colon. | ||
== | =Carcinoma= | ||
===Epidemiology=== | ===General=== | ||
====Epidemiology==== | |||
*Associated with gallstones. | *Associated with gallstones. | ||
*Sex: female > male. | *Sex: female > male. | ||
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===Microscopic=== | ===Microscopic=== | ||
Features: | |||
*Usually adenocarcinoma. | *Usually adenocarcinoma. | ||
**Mimics appearance of pancreatic ductal adenocarcinoma-- but less cellular mucin.<ref name=Ref_DCHH174>{{Ref DCHH|174}}</ref> | **Mimics appearance of pancreatic ductal adenocarcinoma-- but less cellular mucin.<ref name=Ref_DCHH174>{{Ref DCHH|174}}</ref> | ||
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*May be very subtle, i.e. difficult to differentiate from normal glands. | *May be very subtle, i.e. difficult to differentiate from normal glands. | ||
=See also= | |||
*[[Liver]]. | *[[Liver]]. | ||
*[[Gastrointestinal pathology]]. | *[[Gastrointestinal pathology]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] | ||