Korean J Gastroenterol.  2010 Feb;55(2):119-126. 10.4166/kjg.2010.55.2.119.

Histopathologic Analysis of Adenoma and Adenoma-related Lesions of the Gallbladder

• Lee SH
• Lee DS
• You IY
• Jeon WJ
• Park SM
• Youn SJ
• Choi JW
• Sung R

• KMID: 1718295
• DOI: http://doi.org/10.4166/kjg.2010.55.2.119

Abstract

BACKGROUND/AIMS
In order to determine the malignant potential of gallbladder adenoma for progression to carcinoma, we evaluated the histopathologic features of adenoma and adenoma-related lesions on cholecystectomized specimens.
METHODS
Among 1,847 cholecystectomized specimens, 63 specimens from 26 benign adenomas, 9 carcinomas in situ (CIS), and 28 invasive carcinomas were selected. A pathologist reviewed all specimens and selected benign adenomas, CIS in the adenoma, and adenoma residue in invasive carcinomas. Adenomas and adenoma-related lesions were classified according to morphology (tubular, tubulopapillary, and papillary) and the consisting epithelium (biliary, pyloric metaplasia, and intestinal metaplasia). The age and the size of the benign adenomas and carcinomas in the adenoma were also compared.
RESULTS
Adenoma and adenoma-related lesions were found in 34 out (1.8%) of all resected gallbladder. Among 9 CIS and 28 invasive carcinomas, adenoma-related lesions were detected in 7 and 1 case, respectively. All eight carcinomas arising in the adenoma were well-differentiated solitary tumors. The diameters of the carcinomas in the adenoma were, on average, larger than that of the benign adenomas (1.8 cm vs. 0.9 cm, p=0.01). The patients with carcinomas in the adenoma were, on average, older than those with benign adenomas, although the difference was insignificant (57 years vs. 47 years, p=0.09). The morphology and consisting epithelium did not differ between the benign adenomas and carcinomas in the adenoma. The malignant transformation occurred in 23.5% of adenomas.
CONCLUSIONS
Gallbladder adenoma is a rare disease, although malignant transformation occurs frequently. Adenoma is a precancerous lesion and the adenoma-carcinoma sequence is one of the gallbladder cancer carcinogenesis.

Keyword

Gallbladder adenoma; Adenoma-carcinoma sequence

MeSH Terms

Adenoma/epidemiology/*pathology/surgery
Adult
Age Factors
Aged
Carcinoma/epidemiology/pathology/surgery
Cell Transformation, Neoplastic
Cholecystectomy
Cystadenoma/epidemiology/pathology/surgery
Female
Gallbladder Neoplasms/epidemiology/*pathology/surgery
Gallstones/complications
Humans
Male
Middle Aged
Neoplasm Invasiveness

Figure

• 

  Fig. 1. Gallbladder adenomas (H&E stain, (1): ×100, (2): ×400). (A) Tubular adenoma-pyloric gland type, (B) tubulopapillary adenoma-intestinal type, (C) papillary adenoma-biliary type.

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  Fig. 2. Gallbladder adenoma with malignant change (H&E stain, (1): ×100, (2): ×200, (3): ×400). (A) Carcinoma in situ arising in intestinal-type tubulopapillary adenoma. In the upper field (arrow), this tumor showed foci of malignant change, but did not invade to lamina propria. (B) Focal malignant changes in biliary-type adenoma. (C) Invasive carcinoma arising in biliary-type papillary adenoma. Adenoma residue was seen in the left field (arrow) and carcinomatous invasion reached the perimuscular layer.

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  Fig. 3. (A) Size of benign adenomas and adenomas with malignant change. The long diameters of carcinomas in adenoma were longer compared to benign adenomas (1.8±0.9 cm vs. 0.9±0.7 cm; p=0.001). (B) Age of patients having benign adenomas and adenomas with malignant change. Patients having carcinoma were older than those with benign adenoma. But, there was no statistical significance (57± 13 years vs. 47±13 years; p=0.09).

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