Adenomyomatous Hyperplasia of the Gallbladder With Perineural Invasion

Instituto Nacional de Ciencias Médicàs Y Nutrición Salvador Zubirán, Mexico City, Mexico.
American Journal of Surgical Pathology (Impact Factor: 5.15). 11/2007; 31(10):1598-604. DOI: 10.1097/PAS.0b013e31804fa10e
Source: PubMed


We report 9 examples of segmental adenomyomatous hyperplasia of the gallbladder with perineural invasion. Five patients were women and 4 men. Their ages ranged from 49 to 81 years (mean age 64 y). Eight patients had gallbladder calculi. The original pathologic diagnosis of adenocarcinoma was made in 5 patients and of "adenoma malignum" in one. Six patients are disease-free for 2 to 11 years following cholecystectomy, 1 patient died of unrelated causes and 2 were lost to follow-up. Histologically 2 types of adenomyomatous hyperplasia were recognized. The first one characterized by numerous Rokitansky-Aschoff sinuses (RASs) was accompanied by smooth muscle hyperplasia and an expanded subserosal layer containing numerous nerve trunks (6 cases). The second type was characterized by an extensively fibrotic gallbladder wall with numerous RASs but with few or no smooth muscle bundles and an expanded subserosal layer containing abundant nerve-trunks (3 cases). Perineural (7 cases) and intraneural invasion (2 cases) was identified only in the subserosal layer. The lack of p53 reactivity and the very low MIB-1-labeling index provide additional support to the non-neoplastic nature of the lesion. The pseudoinvasive pattern of the RASs, reactive epithelial atypia, and the perineural and intraneural invasion probably contributed to the erroneous diagnosis of adenocarcinoma or "adenoma malignum." The mechanism by which the epithelial structures "invaded" the perineural spaces and the nerves is unclear. We favor the hypothesis that the migration of the benign glandlike structures into the nerves is related to the production of chemotactic factors or signaling substances and the activation of cell receptors.

38 Reads
  • Source
    • "In the present study, pyloric gland metaplasia was recognized in 54%. Albores-Saavedra et al. [7] [8] showed perineural invasion of adenomatous hyperplasia and pyloric glands metaplasia of the gall bladder. In the present study, perineural invasion was not seen in either lesion. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The frequency of gall bladder lesions in cholecystectomies is not clear. The purpose of the present study is to report the morphologies and frequency of gall bladder diseases and lesions of 540 cholecystectomies in the last 10 years in our pathology laboratory. The age of patients ranged from 18 years to 93 years with a mean of 64.75 ±14.43 years. Male to female ratio was 213:327. Of these, 518 cases (96%) had gall stones. Eight (1.5%) were acute cholecystitis, 508 (94.1%) were chronic cholecystitis, 12 (2.2%) were adenocarcinomas, 1 (0.2%) was cystadenocarcinoma, and 11 (2.0%) were normal gall bladders. The frequency of histological lesions were as follows: acute gangrenous inflammation (8 cases, 1.5%), Rokitansky-Aschoff sinuses (RAS) (351 cases, 65%), microliths or inspissated bile in RAS (108 cases, 20%), adenomyomatous changes (16 cases, 3.0 %), focal abscess formations (12 cases, 2.2%), focal xanthogranulomatous changes (15 cases, 2.8%), mucosal ulcers (61 cases, 11.3%), cholesterosis (62 cases, 11%), cholesterol polyp (32 cases, 6%), pyloric gland metaplasia (292 cases, 54%), adenoma (7 cases, 1.3%), xanthogranulomatous cholecystitis (5 cases, 1%), invasive adenocarcinoma (12 cases, 2.2%), and cystadenocarcinoma (1 cases, 0.2%). In adenomyomatous changes, the epithelial proliferation was florid in a few cases, and no perineural invasions were seen. In pyloric gland metaplasia, no perineural invasions were recognized. All the 7 cases of adenoma were of intestinal type. In the 12 adenocarcinoma cases, one case arose in RAS without mucosal involvement, and 9 were tubular adenocarcinomas and 3 were papillary adenocarcinomas and 1 was mucinous adenocarcinoma. In the present series, there were no cases of heterotipc tissue, intestinal metaplasia, intraepithelial neoplasm, and other malignancies. These data may provide basic knowledge of the gall bladder pathologies.
    International journal of clinical and experimental pathology 01/2013; 6(1):91-6. · 1.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Primary sarcoma of the gallbladder (PGBS) is rare, with only 40 cases reported in the literature. Most of these have been diagnosed as leiomyosarcoma. We aimed to evaluate the histological features of a case series of this rare tumor and correlate these with clinical features. Cases recorded as "gallbladder sarcoma" from different institutes were reviewed and the clinicopathological features of these cases were recorded. Only primary gallbladder wall mesenchymal tumors were included. Epithelial tumors, mixed tumors (carcinosarcoma or sarcomatoid carcinoma), and tumors extending into the gallbladder from the abdomen or sarcoma with other known primaries were specifically excluded. PGBS occurred in one male and six females with a median age of 70 (range 64-82) years. Patients presented with acute or chronic cholecystitis, abdominal pain, weight loss, and pruritus. They were generally found to have elevated alkaline phosphatase and bilirubin, and leukocytosis. Tumors ranged from 1.1 to 4 cm with a median size of 3 cm. Most PGBS arose in the body but one arose in the fundus. All tumors were associated with ulcerated mucosa. Based on morphological and immunohistochemical features of the PGBS, there were three myxofibrosarcomas (malignant fibrous histiocytoma, MFH, storiform pleomorphic), one leiomyosarcoma (LMS), one angiosarcoma (AS), and two liposarcomas (LS). All patients received cholecystectomy and three received adjuvant chemotherapy. Follow-up revealed that six patients died of the disease 6 weeks to 2 years after diagnosis and one died of unrelated causes. PGBS are rare and mainly occur in the gallbladder body in middle-aged females. They generally present with acute cholecystitis and have a very poor prognosis. A variety of sarcoma types are found with MFH being the predominant variant.
    Digestive Diseases and Sciences 08/2008; 54(2):395-400. DOI:10.1007/s10620-008-0358-z · 2.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: As emergency physicians perform bedside ultrasound with greater frequency, greater numbers of incidental and potentially unfamiliar sonographic findings will be encountered. Illustrate, discuss, and briefly review literature regarding one such finding and diagnosis in right upper quadrant sonography. A middle-aged woman was evaluated in the Emergency Department for abdominal pain. Limited bedside sonography of the gallbladder revealed mural thickening and comet-tailing. A diagnosis of adenomyomatosis was made. Gallbladder adenomyomatosis can produce ultrasound findings similar to those of more serious and emergent gallbladder diseases. Cognizance of the sonographic details and typical clinical characteristics will allow the emergency physician to appropriately assess and disposition patients with this condition.
    Journal of Emergency Medicine 10/2009; 40(4):415-8. DOI:10.1016/j.jemermed.2009.08.029 · 0.97 Impact Factor
Show more