胆囊皱襞位置异常与胆囊疾病关系的探讨

目的探讨胆囊皱襞异常与胆囊疾病的关系。方法我科1995年1月至2006年10月共发现5000例皱襞胆囊,根据其位置分为胆囊皱襞位置正常组（2500例）和胆囊皱襞位置异常组（2500例）,对其超声资料进行回顾性分析。结果位置正常组中正常胆囊占56%;病变胆囊44%,其中胆囊结石、慢性胆囊炎、慢性胆囊炎合并胆囊结石、急性胆囊炎、胆息肉、胆囊腺肌增生症的发病率分别为11.1%、9.2%、10.7%、8.4%、3.4%、1.1%。位置异常组中正常胆囊占12.1%;病变胆囊达87.9%,其中胆囊结石、慢性胆囊炎、慢性胆囊炎合并胆囊结石、急性胆囊炎、胆息肉、胆囊腺肌增生症的发病率分别为20%、8%、39%、12.9%、5.2%、2.8%。结论胆囊内由于皱襞位置异常,影响了胆汁的排泄及胆囊收缩功能,导致胆汁郁积,是胆囊疾病发生的病因之一,且皱襞越近底部或皱襞横贯性越大,胆囊疾病的发病率越高。     

Paraganglioma of the gallbladder

A case of incidental Gallbladder Paraganglioma is presented. This is the third case found until now in this organ. The parasympathetic origin of this neoplasm is thus discussed.     

Dysplasia of the gallbladder. Its histogenesis and correlation to gallbladder adenocarcinoma

A total of 50 cases of gallbladder dysplasia found adjacent to carcinoma were examined histologically and immunohistochemically for metaplastic changes in order to elucidate the characteristics of the dysplasia of the gallbladder. The incidence of metaplastic changes in the dysplastic mucosa such as the occurrence of endocrine cells, lysozyme-immunoreactive cells, goblet cells, and Paneth cells were 58%, 74%, 32%, and 22%, respectively. Based on the presence or absence of metaplastic changes, these 50 cases of dysplasia were divided into 40 cases (80%) of metaplastic type dysplasia showing at least one marker of metaplasia and 10 cases (20%) of non-metaplastic type dysplasia showing no metaplasia. On the other hand, these 50 cases of carcinoma were divided into 10 cases of non-metaplastic type carcinoma and 40 cases of metaplastic type carcinoma based on the presence or absence of metaplasia in the tumor tissue. The incidence of metaplastic changes in the dysplastic lesions was compared between the dysplasia adjacent to non-metaplastic type carcinoma and that adjacent to metaplastic type carcinoma. The incidence of metaplasia in the dysplastic mucosa adjacent to metaplastic type carcinoma was higher than that adjacent to non-metaplastic type carcinoma with a statistically significant difference. Moreover, the presence or absence of metaplastic changes was also examined in the surrounding dysplasia and non-tumorous mucosa in each case. Most cases of metaplastic type carcinoma were surrounded by dysplasia with metaplastic changes and by metaplastic epithelium, whereas most cases of non-metaplastic type carcinoma were surrounded by dysplasia without metaplasia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Leiomyosarcoma of the gallbladder

A case of leiomyosarcoma of the gallbladder in a 55-year-old woman is presented. The definitive diagnosis of leiomyosarcoma according to the histologic structure of the tumor was made by electron-microscopic study. Ultrastructure of this tumor type is characteristic of presence of myofilaments and cytoplasmic vesicles in the cytoplasm.     

Cholesterosis of the gallbladder

Altogether 238 gall bladders from the necropsy cases and 260 those removed surgically were examined morphologically. Various forms of cholesterosis were found in 5 cases from the first group and in 12 cases from the second. The gall bladder mucous membrane was studied by scanning electron microscopy. Low incidence of this disease is noted in the Central Asia. The mucous membrane surface in health and cholesterosis is described. The conclusion is drawn about the link of the cholesterosis incidence with the traditional nutrition in this area.     

Malacoplakia of the gallbladder

A case of malacoplakia of the gallbladder is described. The cytoplasm of histiocytes in the gallbladder wall was filled with granules positive for periodic acid-Schiff, von Kossa's, and Perls' stains, which is highly suggestive of malacoplakia. Both local inflammation and recent neoplasia could have played a role in the histogenesis of the malacoplakia.     

Extensive ganglioneuromatosis of gallbladder

A case of extensive ganglioneuromatosis (GN) of gallbladder is presented. A 38-year-old man presented with a hepatic hilar mass (? ~ 48 mm) and gall stones. He had undergone total thyroidectomy for medullary thyroid carcinoma 8 years earlier. The hepatic hilus tumor, which had been clinically suspected to be a lymph node metastasis from the medullary thyroid carcinoma, was found to be pheochromocytoma. The gallbladder, resected with a clinical diagnosis of cholelithiasis, showed extensive transmural GN despite a grossly normal appearance. Taking into account the past history, the patient was diagnosed as having multiple endocrine neoplasia 2b (MEN2b)-associated GN of gallbladder and ectopic pheochromocytoma. As GN of gallbladder in MEN2b has been rarely reported, the histological findings are described in detail and a brief review of literature is carried out.     

Gallstones in gallbladder diseases

The correlation between gallbladder stones (gallstones) and various gallbladder diseases was examined. The incidence of gallstones was 47.1% in cases of non-neoplastic epithelial polyp, 48.0% in adenoma, and 59.1% in adenocarcinoma. There was no relation between the incidence of gallstones and sex. The incidence of gallstones in cancer cases showed no difference among histological gradings. Non-neoplastic epithelial polyps, adenomas and carcinomas were divided into metaplastic type and non-metaplastic type based on the presence or absence of metaplastic changes. Comparison of the incidence of gallstones showed that cases of metaplastic-type polyp and adenoma had a higher incidence of gallstones than non-metaplastic-type polyp and adenoma. In the cases of cancer, no differences were observed in the incidence of gallstones between metaplastic-type and non-metaplastic-type carcinomas. However, comparison among early carcinomas showed that metaplastic-type carcinoma had a significantly higher incidence of gallstones than the non-metaplastic-type. These results suggest that gallstones may play an important role in the histogenesis of gallbladder diseases of the metaplastic type.     

Inversion of the gallbladder

A case of inversion of the gallbladder is described, in which the fundus was inverted into the body of the organ. A localized area of adenomyomatosis (adenomyoma) was present at the apex of the invertum.     

Metastatic melanoma to the gallbladder

Melanoma is an aggressive neoplasm with a tendency to recur and metastasize to distant, including unusual sites. Only 2–4% of patients with melanoma develop gastrointestinal tract metastasis with the small intestine being the most frequent site of involvement. Melanoma metastasizing to the gallbladder is rare, is usually associated with disseminated disease and accompanied by a very poor prognosis. Most metastatic gallbladder melanomas originate from cutaneous lesions that may or may not be clinically apparent at the time of diagnosis. The distinction between primary and metastatic gallbladder melanoma is extremely difficult, especially when the primary cutaneous lesion has undergone spontaneous regression. We report a case of disseminated metastatic melanoma presenting as a gallbladder polyp, in the clinical scenario of a regressed primary cutaneous lesion.