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Gallbladder

Benign gallbladder tumors

Adenoma of gallbladder


Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 14 February 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Classified as pyloric, intestinal, foveolar and biliary
● Intestinal subtypes includes tubular, papillary and tubulopapillary (Hum Pathol 2012;43:1506)
● By definition, contains at least low grade dysplastic epithelium
● Found in 0.5% of cholecystectomy specimens, usually asymptomatic
● Increased prevalence found with familial adenomatous polyposis or Peutz-Jeghers syndrome
● 70% women
● Carcinoma within adenoma found in 23% in one study (Korean J Gastroenterol 2010;55:119), but invasive carcinoma rare if < 1 cm
● Entire lesion should be submitted for microscopic examination
● Not a premalignant lesion since different molecular abnormalities from carcinoma (Hum Pathol 1999;30:21)
● Mutations in RAS/RAF/MAPK pathways in adenomas, not adenocarcinomas (Appl Immunohistochem Mol Morphol 2011;19:133)
● Pyloric gland adenoma can progress to carcinoma and be associated with invasion and fatal outcome (Am J Surg Pathol 2012;36:1279)

Treatment
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● Total excision

Gross description
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● 3-25 mm polypoid structure projecting into lumen
● May be sessile
● 90% are single

Gross images
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Tubular adenoma

Micro description
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● Biliary adenoma: composed of columnar cells similar to normal biliary cells of gallbladder
● Foveolar adenoma: has low-grade dysplasia
● Pyloric gland adenoma: usually tubular with pyloric gland features; squamoid morules in 28%
● High grade dysplasia common in pyloric and intestinal adenomas

Micro images
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Tubular adenoma

Positive stains
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● MUC5AC and MUC6 in pyloric gland adenoma, CDX2 in intestinal adenoma (Hum Pathol 2012;43:1506)
● Estrogen receptors (50%)
● Pyloric gland adenoma: aberrant CDX2 expression closely associated with nuclear beta-catenin expression and squamous morules (Virchows Arch 2008;453:521)

End of Gallbladder > Benign gallbladder tumors > Adenoma of gallbladder


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