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Objective:
As there is continuing disagreement among the observers on the differential diagnosis between the epithelial changes/lesions and neoplasms of the gallbladder, this multicentre study was planned in order to assess the rate of the epithelial gallbladder lesions in Turkey and to propose microscopy and macroscopy protocols.
Material and me...
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Objective: Although laparoscopic treatment of gallbladder cancer (GBC) has been explored in the last decade, long-term results are still rare. This study evaluates long-term results of intended laparoscopic treatment for suspected GBC confined to the gallbladder wall, based on our experience over 10 years.
Methods: Between August 2006 and December...
Citations
... There are various methods for the macroscopic examination of cholecystectomy materials (4)(5)(6)(7)(8) and all these methods are important in detecting incidental gallbladder cancer. The Hepato-Pancreato-Biliary (HPB) Pathology Study Group has also conducted a multicenter retrospective study to assess gallbladder lesions and establish common macroscopy and microscopy protocols in our country (9). ...
... We used a form for patient consent. In the first macroscopic examination of the material in accordance with the decided method, the surgical margin of the ductus cysticus was sampled in a way that the sectional side could be seen completely and was sampled completely by removing a full slice from the fundus to the ductus cysticus ( Figure 1) (9). All polyps, if present, in the material (including cholesterol polyps) were sampled. ...
Objective:
Cholecystectomy materials are frequently encountered in routine practice. The aim of this study was to determine the true frequency of gallbladder lesions, the diagnostic consistency, and standardization of reports after macroscopic sampling and microscopic evaluation based on previously defined criteria.
Material and method:
14 institutions participated in the study within the Hepato-Pancreato-Biliary Pathology Study Group. Routinely examined cholecystectomies within the last year were included in the study in these institutions. Additional sampling was performed according to the indications and criteria. The number of blocks and samples taken in the first macroscopic examination and the number of blocks and samples taken in the additional sampling were determined and the rate of diagnostic contribution of the additional examination was determined.
Results:
A total of 5,244 cholecystectomy materials from 14 institutions were included in the study. Additional sampling was found to be necessary in 576 cases (10.98%) from all institutions. In the first macroscopic sampling, the mean of the numbers of samples was approximately 4 and the number of blocks was 2. The mean of the numbers of additional samples and blocks was approximately 8 and 4, respectively. The diagnosis was changed in 144 of the 576 new sampled cases while the remaining 432 stayed unaltered.
Conclusion:
In this study, it was observed that new sampling after the first microscopic examination of cholecystectomy materials contributed to the diagnosis. It was also shown that the necessity of having standard criteria for macroscopic and microscopic examination plays an important role in making the correct diagnosis.
... In our study, the most common polyp type was cholesterol polyp (3.7%), followed by inflammatory polyp (0.05%), tubular adenoma (0.05%), and pyloric gland adenoma (0.05%). Pyloric gland metaplasia (particularly in atrophic epithelium, in 66-84% of cholecystectomy materials) is the most common metaplasia type, and intestinal metaplasia (in 10-30% of cholecystectomy specimens) is the second common metaplasia type in the gallbladder [2,3,7]. In a study by Sharma et al. [8], pyloric metaplasia was observed in 30.2% of cases. ...
... The rate of dysplasia in cholecystectomy materials varies between 0.7% and 34% in various series. [3,7]. The rate of dysplasia was found to be 0.25% in the study of Esendağlı et al. [7 ]. ...
... [3,7]. The rate of dysplasia was found to be 0.25% in the study of Esendağlı et al. [7 ]. In the evaluation of gallbladder pathologies, it is recommended to interpret the changes as reactive if there is ulceration and intense inflammation in cases which reactive atypia and low-grade dysplasia can be mimicked. ...
Cholecystectomy is one of the most common types of surgical operations and includes many pathologies ranging from the most common cholecysistitis to randomly detected dysplasia and cancer. In this study, it is aimed to obtain a general regional incidence by documenting gallbladder pathology data in Usak province and to contribute to literature in this field. Between 2015 and 2019, 1712 cholecystectomy specimens were analyzed retrospectively in the Department of Pathology, Usak University Training and Research Hospital; adenocarcinoma (primary invasive carcinomas), low and high grade dysplasias (Biliary intraepithelial neoplasia - BillN1,2 ), neoplasms / adenomas, intestinal pyloric metaplasia, reactive atypia and other lesions were re-evaluated with Olympus CX41 light microscope and based on recent diagnoses. Epithelial changes / lesions were reported in 11.3% of cholecystectomy materials. Of these epithelial lesions, 6.18% had adenocarcinoma, 4,6% had high-grade dysplasia, 29,3% had low-grade dysplasia, 27,3% reactive / regenerative atypia and 2,06% - 14,9% - 15,4 %, neoplastic polyps, intestinal metaplasia and intestinal + pyloric metaplasic respectively. Of the cases with dysplasia and carcinoma, 39.3% and 33.4% were male, 60.7% and 66% female, respectively. The mean age was 57 in dysplasia and 66 in carcinoma. The female / male ratio in carcinoma cases was 2/1 and 41.6% of these cases had stones. The remaining lesions (88,7%) were non-neoplastic polypoid / hyperplastic leions and pyloric metaplasia. According to our findings, we suggest that, even in the absence of clinical symptoms, an adequate number of samples should be taken from the specimen during histopathological examination, especially in elderly women with long-standing stones due to the risk of developing precancerous lesions. [Med-Science 2020; 9(1.000): 26-32]
... Antral metaplasia, hyperplasia, non-neoplastic polyps represent non-neoplastic lesions and can be found in around 9-59.5% of cases after cholecystectomy. 15,16 The bile-type epithelium with columnar cells and round to oval uniform nuclei differ from the dysplastic changes that are characterized by the loss of epithelium architecture, increased height of cells and nuclear crowding with presence of mitotic figures (Figure 3). While reactive changes blend gradually with the normal cells' architecture, real dysplasia has sharp demarcated areas adjacent to the normal biliary epithelium. ...
Approximately 1 to 3.5% of cholecystectomies are found to have incidental dysplasia on histological examination. Cases of positive resection margins on the cystic stump are rare and evidence lack. The aim of this article was to systematically review the literature and to suggest a possible management algorithm. We searched PubMed, Cochrane Library and Google Scholar databases by combining “cholecystectomy” and “dysplasia” and “cystic” according to preferred reporting items for systematic reviews and meta-analyses guidelines. Studies providing information about cystic duct dysplasia with positive resection margin after cholecystectomy were included. We identified 113 articles, of which three were considered eligible. Five patients had a high-grade dysplasia, one patient had a carcinoma and one had a low-grade dysplasia. Median follow-up was of 10.5 months (range: 0.5-26.6 months), no evidence of recurrence was found in patients with dysplasia, while the patient with diagnosis of cholangiocarcinoma died during follow-up. Patients with positive resection margins for dysplasia after cholecystectomy should be considered for a surgical treatment according to clinical and pathological factors. Simple cystic duct stump excision was suggested and seems to be safe and effective with no evidence of recurrence during follow-up when a R0 resection is achieved. A multidisciplinary approach and a surveillance program should be always taken into account.
... Due to the lesions detected in the microscopic examination but that could not be detected in the macroscopic examination, the method and the required quantity of sampling from gallbladder material has been a subject of debate for many years (6,7). A macroscopic evaluation guide was prepared and the agreed macroscopy protocol was defined by the Turkish Federation of Pathology Societies, Hepatopancreatobiliary Pathology Working Group for the macroscopic examination and sampling method of the cholecystectomy materials (8). Before this protocol, gallbladders without a peculiarity were examined by one sample from each of the fundus, body and neck regions in our laboratory. ...
Objective:
Adenomyoma, a reactive and hamartomatous lesion of the gallbladder, is included in the differential diagnosis of several benign and malignant lesions. Macroscopic sampling is very important in the determination of these lesions. The agreed macroscopy protocol in recent years has been prepared by the Hepatopancreatobiliary Pathology Working Group. We aimed to evaluate the clinicopathologic properties of adenomyoma cases in the gallbladder and the contribution of new macroscopy techniques to the diagnosis of adenomyoma in the pre-protocol and post-protocol parts of a one-year period.
Material and method:
Two institutes were included in the study. Adenomyoma cases diagnosed in the pre-protocol and post-protocol periods of one year duration were included in the study. Slides and demographic properties of the cases were reexamined.
Results:
While adenomyoma was present in 22 of 1879 gallbladder before the protocol, it was observed in 32 of 1781 gallbladders in the post-protocol period. 17 of the cases were male and 37 were female. The mean age of the cases was 51.8. 52% of the lesions were located in the fundus. A gallstone was observed in 37 cases, and cholesterolosis in 14 cases. In the comparison of the two periods, the number of cases was lower in the post-protocol period but a 0.6% increase in the diagnosis of adenomyoma was found.
Conclusion:
Adenomyoma is one of the lesions of the gallbladder that should be recognized but can be easily overlooked macroscopically. When we conducted the sampling according to the last protocol, the increase in the diagnosis of adenomyoma showed that adequate and accurate sampling was very useful for the detection of adenomyoma in the gallbladder.
... The carcinogenesis of biliary neoplasm is thought to be a multi-step process from metaplasia to malignant degeneration. Antral metaplasia, hyperplasia, non-neoplastic polyps represent non-neoplastic lesions and can be found in around 9 -59.5% of cases after cholecystectomy [15,16]. The bile-type epithelium with columnar cells and round to oval uniform nuclei differ from the dysplastic changes that are characterized by the loss of epithelium architecture, increased height of cells and nuclear crowding with presence of mitotic gures ( gure 3). ...
Purpose Approximately 1 to 3.5% of cholecystectomies are found to have incidental dysplasia on histological examination. Cases of positive resection margins on the cystic stump are rare and evidence lack. The aim of this article was to systematically review the literature and to suggest a possible management algorithm. Methods We searched PubMed, Cochrane Library and Google Scholar databases by combining “cholecystectomy” AND “dysplasia” AND “cystic” according to PRISMA guidelines. Studies providing information about cystic duct dysplasia with positive resection margin after cholecystectomy were included. Results The searches identified 109 articles from PubMed and 4 articles from Cochrane Library and Google Scholar, of which three were eligible. Five were found to have post-operative high-grade dysplasia, one patient had a carcinoma and one had a low-grade dysplasia. Median follow-up was of 10.5 months (range: 0.5 – 26.6 months), no evidence of recurrence was found in patients with dysplasia, while the patient with diagnosis of cholangiocarcinoma died during follow-up. Conclusions Patients with positive resection margins for dysplasia after cholecystectomy should be considered for a surgical treatment. The latter depends on several factors related to the patient and the grade of dysplasia itself. Simple cystic duct stump excision has been suggested and it seems to be safe and effective with no evidence of recurrence during follow-up when a R0 resection is achieved. A multidisciplinary approach and a surveillance program should be always taken into account.
... Also Esenda Ğli G et al reported incidence of GB adenocarcinoma as 0.4% which was lower than our study. [23] Presence of gall stones is important factor for development of GBC. We found 6 out 12 cases associated with gall stones. ...
Background : The histopathological spectrum of gallbladder lesions is extremely variable and its frequency in cholecystectomies is not clear. This spectrum varies from non- neoplastic lesions like cholecystitis, gall stones, cholesterolosis, hyperplasia to neoplastic disorders. As there is limited literature available especially from this part of India, the aim of this study is to find incidences of various lesions of gall bladder in a tertiary care hospital. Methods: Five years retrospective and prospective analysis of 1096 cholecystectomies was carried out. Relevant clinical details of patient were noted down. Cholecystectomy specimens were studied for gross and microscopic examination after fixation of specimen with 10% formalin and microscopically examining H& E slides. Results: Overall, 1096 cases of cholecystectomies were analysed which revealed female preponderance with peak incidence of non-neoplastic lesion in 4th decade and neoplastic lesions in 5th decade. Gall stones were seen in 52% of cases. Incidence of various lesions was chronic cholecystitis 93.1%, acute cholecystitis 2.91%, chronic follicular cholecystitis 0.72%, xanthogranulomatous cholecystitis 1.1%, cholesterolosis 0.46%, eosinophilic cholecystitis 0.18%, and carcinoma of gall bladder 1.1%.
... 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][50][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]. Still, Barrett's epithelium metaplastic lineages arise in the setting of injured squamous epithelia, so their origin has been controversial [53]. ...
The gastrointestinal mucosae provide a critical barrier between the external and internal milieu. Thus, damage to the mucosa requires an immediate response to provide appropriate wound closure and healing. Metaplastic lineages with phenotypes similar to the mucous glands of the distal stomach or Brunner’s glands have been associated with various injurious scenarios in the stomach, small bowel and colon. These lineages have been assigned various names including pyloric metaplasia, pseudopyloric metaplasia, ulcer-associated cell lineage (UACL) and spasmolytic polypeptide-expressing metaplasia (SPEM). A re-examination of the literature on these various forms of mucous cell metaplasia suggests that pyloric type mucosal gland lineages may provide a ubiquitous response to mucosal injury throughout the gastrointestinal tract as well as in the pancreas, esophagus and other mucosal surfaces. While the cellular origin of these putative reparative lineages likely varies in different regions of the gut, their final phenotypes may converge on a pyloric type gland dedicated to mucous secretion. In addition to their healing properties in the setting of acute injury, these pyloric type lineages may also represent precursors to neoplastic transitions in the face of chronic inflammatory influences. Further investigations are needed to determine how discrete molecular profiles relate to the origin and function of pyloric-type metaplasias previously described by histological characteristics in multiple epithelial mucosal systems in the setting of acute and chronic damage.
The mucosa of the body of the stomach (i.e., the gastric corpus) employs two overlapping, depth-dependent mechanisms to respond to injury. Superficial injury heals via surface cells with histopathological changes like foveolar hyperplasia. Deeper, usually chronic, injury/inflammation, most frequently induced by the carcinogenic bacteria H pylori, elicits glandular histopathological alterations, initially manifesting as pyloric (also known as pseudopyloric) metaplasia. In this pyloric metaplasia, corpus glands become antrum (pylorus)-like with loss of acid-secreting parietal cells (atrophic gastritis), expansion of foveolar cells, and reprogramming of digestive enzyme-secreting chief cells into deep antral gland-like, mucous cells. Following acute parietal cell loss, chief cells can reprogram through an orderly, stepwise progression (paligenosis) initiated by IL-13-secreting innate lymphoid cells (ILC2s). First, massive lysosomal activation helps mitigate reactive oxygen species (ROS) and remove damaged organelles. Second, mucus and wound-healing proteins (e.g. TFF2) and other transcriptional alterations are induced, at which point the reprogrammed chief cells are recognized as mucus-secreting Spasmolytic Polypeptide Expressing Metaplasia (SPEM) cells. In chronic severe injury, glands with pyloric metaplasia can harbor both actively proliferating SPEM cells and eventually intestine-like cells. Gastric glands with such lineage confusion (mixed incomplete intestinal metaplasia and proliferative SPEM) may be at particular risk for progression to dysplasia and cancer. A pyloric-like pattern of metaplasia after injury also occurs in other gastrointestinal organs including esophagus, pancreas and intestines, and the paligenosis program itself seems broadly conserved across tissues and species. Here, we discuss aspects of metaplasia in stomach, incorporating data derived from animal models and work on human cells and tissues in correlation with diagnostic and clinical implications.
Amaç: Kolesistektomi ikinci basamak devlet hastaneleri Genel Cerrahi servislerinde en sık uygulanan ameliyatların başında gelmektedir. Kolesistektomi spesimenlerinin histopatolojik değerlendirilmesi literatürde yaygın olarak ele alınmıştır. Ancak morfolojik değerlendirme oldukça kısıtlıdır. Bu çalışma ile semptomatik benign hastalıklar nedeniyle kolesistektomi yapılan hastaların kolesistektomi spesimenlerinin mikroskobik ve makroskopik özelliklerinin yanı sıra morfolojik özelliklerinin de değerlendirilmesi amaçlandı. Materyal ve Metot: Yozgat Şehir Hastanesinde Ocak 2014 ve Mart 2019 tarihleri arasında Genel Cerrahi Servisinde gerçekleştirilen toplam 961 kolesistektomi spesimeni geriye dönük incelendi. Çalışma hastane elektronik verilerinden hasta bilgilerine ulaşılarak geriye dönük gerçekleştirildi. Hastaların yaş, cinsiyet, uygulanan ameliyatın şekli, histopatolojik tanı, safra taşının olup olmadığı, kolesistektomi spesimenin uzunluğu, genişliği ve en kalın duvar ölçüleri değerlendirmeye alındı.Bulgular: Toplam 961 hastanın 734 (%76,4) kadın, 227 (%23,6)’sı erkeklerden oluşmaktaydı. Ameliyatların 900 tanesi laparoskopik (%93,7) gerçekleştirildi. Safra kesesi genişliği açısından her iki cinsiyet arasında anlamlı fark saptanmazken (p=0,23), safra kesesi uzunluğu (p=0,04), safra kesesi duvar kalınlığının (p=0,001) erkeklerde fazla olduğu saptandı. Kronik kolesistit kadınlarda, subakut ve akut kolesistit erkeklerde daha sık görüldü (p=0,001). Kolelitiazis ve kolesterol oranlarına cinsiyetin etkisi saptanmadı (p=0,63). Yaşın, kolesterol ve kolelitiazis arasındaki korelasyon ilişkinin çok zayıf olduğu görüldü (0<r<20). Spesimenlerin % 14,4’de makroskopik bulgular hakkında raporlama yoktu. Toplam üç spesimende malignite ve üç spesimende neoplastik polip saptandı.Sonuç: İnsidental safra kesesi karsinomu ikinci basamak hastanelerde daha sık karşılaşılmaktadır. Bu yüzden özellikle bu tür hastanelerde rutin olarak kolesistektomi spesimenleri histopatolojik değerlendirmeye gönderilmelidir. Gönderilen spesimenlerinde daha sağlıklı mikroskobik, makroskopik ve morfolojik özelliklerinin değerlendirilmesi için standardize edilmiş patoloji raporlamasına ihtiyaç vardır.
