Pyloric gland metaplasia with perineural invasion of the gallbladder

Abstract

BACKGROUND Metaplastic pyloric glands have been described in a variety of organs including the gallbladder, in which they can extend into the muscular wall and serosa. METHODS Clinical, histologic, and immunohistochemical features of four cases of gallbladder florid pyloric gland metaplasia with perineural and intraneural invasion are analyzed. RESULTS The patients with pyloric gland metaplasia and perineural and intraneural invasion were all females ages 57–72 years. A preoperative diagnosis of chronic cholecystitis and cholelithiasis was made for all four patients, but a histologic diagnosis of adenocarcinoma was made for two patients and entertained in two others. Macroscopically the gallbladders showed changes usually associated with chronic cholecystitis. No intraluminal masses were observed in any of the gallbladders. The characteristic microscopic features included florid pyloric gland metaplasia, proliferation of medium‐sized nerve trunks more prominent in the muscular layer and serosa, and perineural and intraneural invasion by the metaplastic glands lined by cytologically bland cuboidal or columnar mucin‐containing cells. At last follow‐up all patients were alive and symptom free 1‐7 years after laparoscopic cholecystectomy. CONCLUSIONS Pyloric gland metaplasia of the gallbladder should be added to the long and increasing list of benign epithelial proliferations that are associated with perineural and intraneural invasion. This lesion should not be mistaken for adenocarcinoma of the gallbladder, a misinterpretation that may have serious therapeutic implications. The pathogenesis of this phenomenon is unknown. Cancer 1999;86:2625–31. © 1999 American Cancer Society.

Reactive Neuroepithelial Aggregates of the Skin

“…Ackerman [10], in 1957, first described breast ducts within a nerve in a biopsy specimen from a patient without other evidence of carcinoma. Subsequently, such perineural involvement by nonneoplastic epithelium has been reported not only in the breast [ 1 1-14] but also in prostate [ 1 5 ], pancreas [ 1 6-1 8], vas deferens [19], gallbladder [20,21] and endometriosis [22].…”

Nerve infiltration by benign biliary glands – a diagnostic dilemma

“…Although perineural and intraneural infiltration is most commonly a feature of malignant neoplasms, it has also been documented in numerous benign, nonneoplastic epithelial proliferations, including sclerosing adenosis of the breast, normal pancreatic ducts, nodular hyperplasia of the prostate, endometriosis, and vasitis nodosa, as well as in benign vascular tumours. 2 When recognised, therefore, it should not always be considered to be a diagnostic feature of malignancy.…”

Gastric mucin is expressed in a subset of endocervical tunnel clusters: type A tunnel clusters of gastric phenotype

“…Aberrant gastric mucin expression in benign and malignant lesions has been recognized in several organs, including the duodenum, 18 small and large intestines, 30–33 gallbladder, 34–36 the common bile duct 37 and pancreas 38,39 . In most of these organs, gastric (or pyloric gland) metaplasia is considered to result from longstanding chronic inflammation.…”

“…Based on these observations, it is reasonable to suggest that type A TC of gastric phenotype are closely related to lobular endocervical glandular hyperplasia of gastric phenotype. Aberrant gastric mucin expression in benign and malignant lesions has been recognized in several organs, including the duodenum, 18 small and large intestines, [30][31][32][33] gallbladder, [34][35][36] the common bile duct 37 and pancreas. 38,39 In most of these organs, gastric (or pyloric gland) metaplasia is considered to result from longstanding chronic inflammation.…”