Are histological alterations observed in the gallbladder precancerous lesions?

Abstract

INTRODUCTIONGallbladder cancer, which is characterized by rapid progression and a poor prognosis, is a complex disease to treat. Unfortunately, little is known currently about its etiology or pathogenesis. A better understanding of its carcinogenesis and determining risk factors that lead to its development could help improve the available treatment options.METHODBased on this better understanding, the histological alterations (such as acute cholecystitis, adenomyomatosis, xanthogranulomatous cholecystitis, polyps, pyloric metaplasia, intestinal metaplasia, dysplasia, cancer and others) in gallbladders from 1,689 patients who underwent laparoscopic cholecystectomy for cholecystolithiasis were analyzed. The association of these gallbladder histological alterations with clinical data was studied.RESULTSGender analysis revealed a greater incidence of inflammatory changes in males, while dysplasia and cancer were only found in women. The incidence of cholesterolosis was greater in the patients 60 years of age and under, and the incidence of adenomyomatosis and gangrene was greater in the elderly patients. A progressive increase in the average age was observed as alterations progressed through pyloric metaplasia, intestinal metaplasia, dysplasia and then cancer, suggesting that the metaplasia-dysplasia-carcinoma sequence may occur in gallbladder cancer. Gallbladder histological alterations were also observed in asymptomatic patients.CONCLUSIONThe results of this study suggest that there could be an association between some histological alterations of gallbladder and cancer, and they also suggest that the metaplasia-dysplasia-carcinoma sequence could in fact be true in the case of gallbladder cancer. Nevertheless, further studies directed towards a perfect understanding of gallbladder carcinogenesis are required.

Impact of Routine Histopathological Examination of Gall Bladder Specimens on Early Detection of Malignancy - A Study of 4,115 Cholecystectomy Specimens

“…Several studies have reported association between pyloric metaplasia and dysplasia, pyloric metaplasia and cancer and an association between intestinal metaplasia and pyloric metaplasia, dysplasia and cancer (Yamagiwa et al, 1986;Meirelles-costa, 2010). In this study, we observed these changes in and around tumor area, supporting the first hypothesis.…”

A Comparative Study of Clinicopathological Features between Chronic Cholecystitis Patients with and without Helicobacter pylori Infection in Gallbladder Mucosa

“…[33]–[35] In our study, metaplasia was identified in 7.67% of the included patients and it was shown to be statistically correlated with H. pylori infection in gallbladder mucosa ( p  = 0.047). Metaplasia is believed to be a strong histological sign for diagnosis of moderate or severe chronic cholecystitis because it is rarely observed in gallbladder autospy in which only mild inflammatory changes present.…”

Pyloric metaplasia, pseudopyloric metaplasia, ulcer‐associated cell lineage and spasmolytic polypeptide‐expressing metaplasia: reparative lineages in the gastrointestinal mucosa

“…These metaplastic mucous cell lineages underlie the development of PanIN lesions in the pancreas. Pyloric metaplasia and intestinal metaplasia have also been noted in association with chronic cholecystitis and implicated in metaplasia to neoplasia progression similar to that in gastric carcinogenesis [49–51]. Gastric and intestinal metaplasia lineages are pathognomonic of Barrett’s epithelium and the organization of the metaplastic glands resembles the structure of pyloric glands [52].…”