Gallbladder & extrahepatic bile ducts
Gallbladder dysplasia and malignancy
Dysplasia
Author: Hanni Gulwani, M.B.B.S.
Last author update: 1 September 2012
Last staff update: 1 May 2023
Copyright: 2003-2023, PathologyOutlines.com, Inc.
PubMed Search: Dysplasia[TI] gallbladder
Table of Contents
Definition / general | Pathophysiology / etiology | Carcinoma in situ | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosisCite this page: Gulwani H. Dysplasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/gallbladderdysplasia.html. Accessed September 30th, 2023.
Definition / general
- Neoplastic intraepithelial proliferation
- Present in 1 - 34% of cholecystectomy specimens (severe dysplasia in 1 - 3%)
- May be associated with invasive carcinoma
- Diagnose with caution if extensive ulceration or acute inflammation
- Extensive sampling recommended after diagnosis (can use jelly roll technique used for placentas)
- Submitting the entire gallbladder in cases of dysplasia is not justified; proper review of the gross specimen and submission of up to 4 additional sections identify all significant lesions (Am J Clin Pathol 2012;138:374)
- Statistical significant association has been noted between intestinal metaplasia and dysplasia (Gastroenterol Hepatol (N Y) 2008;4:735)
Pathophysiology / etiology
- Suggested route for development of invasive carcinoma of gallbladder (Arch Pathol Lab Med 2005;129:386)
Gallstones → chronic inflammation → antral type metaplasia → intestinal metaplasia → dysplasia → carcinoma
- Major pathway to invasive gallbladder carcinoma is via dysplasia; adenomas do not appear to be important precursors
- Hyperplasia may not be part of this sequence
Carcinoma in situ
- Often an incidental finding after cholecystectomy for cholecystitis or cholelithiasis (Arch Pathol Lab Med 2010;134:1621)
- Not associated with tumor related death
- May extend into Rokitansky-Aschoff sinuses resembling invasive carcinoma but is connected to surface epithelium (Am J Surg Pathol 2004;28:621)
- Mixture of benign and neoplastic epithelium
- Has inspissated bile in long dilated spaces
- Desmoplasia but no invasion into smooth muscle bundles, no perineurial invasion
- May arise in adenomyomatous hyperplasia
Gross description
- Granular mucosal patches or no gross findings
Microscopic (histologic) description
- Involves flat mucosa, papillae, Rokitansky-Aschoff sinuses, metaplastic pyloric glands
- Abrupt transition from normal mucosa
- May resemble carcinoma but no desmoplasia
- Often goblet cells
- Low grade: crowding and hyperchromatic and elongated nuclei
- High grade: low grade features plus stratification; includes carcinoma in situ
Microscopic (histologic) images
Images hosted on other servers:
Various images
Differential diagnosis
- Reactive epithelial changes: no abrupt transition from normal mucosa, prominent nucleoli, epithelial atypia proportional to stromal atypia
