Clinicopathological Study of Mass-forming Gallbladder Cancer Focusing on the Grade of Cellular Dysplasia

Abstract

The relationship between the clinicopathological features and the grade of cellular dysplasia of the neoplastic glands in mass-forming gallbladder cancer was investigated. In this retrospective study, 41 mass-forming 1 cm gallbladder cancer specimens from 83 resected cases were examined. Tumors were classi ed into three groups : Group A had intraluminal masses consisting of neoplastic glands with only low-grade dysplasia ; Group B had mixed low-and high-grade dysplasia, and Group C had only high-grade dysplasia. Of the 41 tumors, 13 were classi ed as Group A, 11 as Group B, and 17 as Group C. For Group A, B, and C, respectively, the mean tumor diameter was 1.6, 3.7 and 3.4 cm ; macroscopic type pedunculated / semi-pedunculated / sessile was 7 / 5 / 1, 4 / 6 / 1 and 0 / 10 / 7 ; frequency of an invasive component inside the mass was 0 , 9 and 82 ; and cell lineage biliary / metaplastic / mixed was 2 / 1 / 10, 8 / 1 / 2 and 14 / 1 / 2. In addition, invasion depth Tis T1 / T2 / T3 was 13 / 0 / 0, 7 / 4 / 0 and 3 / 10 / 4 ; lymph node metastases were present in 0 , 9 and 24 of patients ; 3-year survival rate was 100 , 100 and 82 ; and 5-year survival rate was 100 , 100 and 69 , for A, B and C, respectively. Signi cant intergroup differences were seen for positive lymph node metastasis rate and 5-year survival rate. The present study indicates that the clinicopathological features of mass-forming gallbladder cancer are different depending on the grade of cellular dysplasia of the mass lesion. The tumors in Groups A and B were of lower malignancy than those in Group C and the prognosis of patients in the former groups was excellent. Group A and B tumors may be intracholecystic papillary-tubular neoplasms, a recently proposed new disease concept.

Adenomatous Hyperplasia of the Gallbladder in the Setting of Mirizzi Syndrome, Mimicking Adenocarcinoma of the Gallbladder

“…Histological features of adenomatous hyperplasia include gallbladder mucosa with elongated papillary folds, fibrotic core, and a mild lymphocytic infiltrate. 2 , 12 The surface shows hyperplasia of metaplastic pyloric-type glands, while branching mucous glands are found in deeper layers, focally filling the lamina propria. 2 , 12 , 13 Both adenomyomatosis and adenomatous hyperplasia occur in the setting of chronic cholecystitis and in conjunction with the presence of gallstones.…”

“… 2 , 12 The surface shows hyperplasia of metaplastic pyloric-type glands, while branching mucous glands are found in deeper layers, focally filling the lamina propria. 2 , 12 , 13 Both adenomyomatosis and adenomatous hyperplasia occur in the setting of chronic cholecystitis and in conjunction with the presence of gallstones. 14 For our patient, histopathology revealed fibro-muscular adipose tissue, in the presence of proliferated bland glands, and mild chronic inflammatory infiltrates without hypertrophy of the muscular layer, differentiating it from adenomyomatosis.…”

“… 2 , 6 Gallbladder wall thickening and intramural diverticula containing cholesterol crystals, or calculi, are pathognomonic of adenomyomatosis. 1 , 2 , 6 , 12 In contrast, in adenomatous hyperplasia, there is deposition of triglycerides and cholesterol esters within macrophages in the lamina propria, and the polyp is covered by normal epithelium. 6 , 9 However, gallbladder malignancy should be suspected when there are features of a focal mass with locoregional lymphadenopathy, metastases, and features of biliary obstruction at the level of the porta hepatis.…”