Gallbladder & extrahepatic bile ducts

Gallbladder dysplasia and malignancy


Last author update: 1 September 2012
Last staff update: 1 May 2023

Copyright: 2003-2023,, Inc.

PubMed Search: Dysplasia[TI] gallbladder

Hanni Gulwani, M.B.B.S.
Page views in 2022: 7,270
Page views in 2023 to date: 7,357
Cite this page: Gulwani H. Dysplasia. website. 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
Back to top
Image 01 Image 02