Presentation
US performed due to RUQ pain.
Patient Data
Selected images of the gallbladder showing a large gallstone and a 1.2 cm pedunculated polyp with internal vascularity. The gallbladder wall is otherwise thin and smooth. No pericholecystic fluid.
Case Discussion
The incidental gallbladder polyp has increased risk of malignancy given the size, cholecystectomy was recommended:
Macroscopy: Labeled " Gallbladder". An intact gallbladder 80 x 35 mm. The serosa is smooth. The cystic duct is clamped but patent and cystic duct node are identified. Cystic duct resection margin inked blue. Wall is mostly 3mm and mucosa is hemorrhagic with a wide base sessile polyp, 20 x 13 mm at the junction of the body and fundus. On sectioning, polyp extends to the surrounding gallbladder. A lobulated, ovoid yellow gallstone, 17 mm is seen. 3 loose pieces of green polypoid tissue are also seen within the lumen, 7-10 mm. Hepatic bed resection margin inked green. No obvious roughened liver parenchyma is seen at presumed attachment hepatic bed, mostly fatty.
Microscopy: The sections of the macroscopically described polyp show a poorly differentiated adenocarcinoma arising within a tubular adenoma with high-grade dysplasia. The carcinoma comprises predominantly single cells, cords, narrow trabeculae and poorly formed glands formed by atypical rounded cells with moderately abundant eosinophilic to mucinous cytoplasm and frequent signet ring cell morphology. Carcinoma invades into subserosa but no serosal invasion seen. No vascular or perineural invasion is identified.
Elsewhere, the sections of gallbladder wall show muscular hypertrophy, fibrosis, Rokitansky-Aschoff sinuses and a mild chronic inflammatory cell infiltrate. No acute inflammation is seen. There is extensive high-grade epithelial dysplasia within flat mucosa away from the invasive carcinoma.
No dysplasia or malignancy is identified within the section of the cystic duct resection margin although there is extensive epithelial denudation, limiting assessment for dysplasia. Carcinoma is not present in sections taken through the apparent hepatic bed resection margin.
Conclusion: Gallbladder and separately submitted cystic duct lymph node:
- Poorly differentiated, signet ring cell adenocarcinoma of the gallbladder arising within a tubular adenoma with high-grade dysplasia.
- - Invasion into subserosa.
- - No vascular or perineural invasion identified.
- - Negative resection margins.
- - Negative cystic duct lymph node (0/1)
- - pT2a, N0.
- Background changes of chronic cholecystitis with extensive high-grade dysplasia
- Cholelithiasis
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