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.     

Usefulness of lavage cytology during endoscopic transpapillary catheterization into the gallbladder in the cytological diagnosis of gallbladder disease

Many studies have reported methods of cell collection involving percutaneous transhepatic cholangiodrainage (PTCD) and fine‐needle aspiration cytology for the diagnosis of gallbladder disease. However, few studies have described the use of a transpapillary approach, i.e., endoscopic transpapillary catheterization into the gallbladder (ETCG). In this study, we analyzed cells collected by ETCG to evaluate its usefulness in the cytological diagnosis of gallbladder disease. The subjects were 19 patients who had undergone ETCG for the diagnosis of gallbladder disease. Of these patients, 11 and 8 had gallbladder cancer and benign gallbladder disease, respectively. We also evaluated the diagnostic accuracy of PTCD cytology performed in 15 patients with gallbladder cancer. Specimens were cytologically diagnosed as normal or benign, indeterminate, suspected malignancy, malignant, and inadequate in 47% (9/19), 11% (2/19), 0% (0/19), 37% (7/19), and 5% (1/19) of patients, respectively. Specimens were diagnosed as malignant, indeterminate, normal or benign, and inadequate in 7, 2, 1, and 1, respectively, of the 11 patients diagnosed with gallbladder cancer. The sensitivity and specificity of ETCG cytology were 78 and 100%, respectively, whereas the diagnostic accuracy of PTCD cytology was 20% (3/15). None of the patients developed complications of ETCG. Despite its technical difficulty, ETCG for bile cytology allows the collection of adequate cell numbers from patients with benign disease or gallbladder cancer and facilitates a cytological diagnosis, making it a useful method for collecting cells. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

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。     

Diffuse ganglioneuromatosis in small intestine associated with neurofibromatosis type 1

Ganglioneuromatosis of the gastrointestinal tract is a rare condition that has an established association with the multiple endocrine neoplasia syndrome, type IIb. Its occurrence in neurofibromatosis, in which the large intestine is usually affected, is much rarer. We report a case of diffuse ganglioneuromatosis of the small bowel, found incidentally during surgery for a malignant peripheral nerve sheath tumor arising in the retroperitoneum in a 32-year-old man with neurofibromatosis type 1, and review previously reported cases.     

Endocrine cell carcinoma of the gallbladder

An endocrine cell carcinoma in the gallbladder of a 59-year-old woman is reported. The morphological features of this diagnosis are compared with 14 previously reported primary gallbladder carcinoid tumours that had metastasized. The histogenesis and current classification of endocrine cell tumours is discussed.     

Signet-ring cell carcinoid of the gallbladder

A case of signet-ring cell carcinoid of the gallbladder is reported. The tumour diffusely infiltrated the gallbladder wall and extensively ulcerated the mucosa. Neoplastic nests were composed of numerous signet-ring cells mixed with clear endocrine cells. The latter expressed chromogranin A, gastrin and somatostatin and contained neurosecretory granules. The diagnostic problem of differentiating between signet-ring cell carcinomas and composite adenocarcinoma-carcinoid tumours is discussed.     

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.     

Simultaneous xanthogranulomatous cholecystitis and primary adenocarcinoma of gallbladder

We describe the clinicopathological features of xanthogranulomatous cholecystitis and adenocarcinoma arising in the same gallbladder, a circumstance only briefly alluded to in the existing literature.     

Ciliated foregut cyst of the gallbladder: a case report and review of the literature

A case is presented of a ciliated cyst of the gallbladder in a 36-year-old Korean woman which was incidentally found on ultrasonographic study. A cystic mass measuring 1.5 x 1 x 1 cm was found in the fundus of the gallbladder. The cyst was unilocular and intramural without communication to the lumen. Microscopically, the cyst wall was lined by a single layer of pseudostratified, ciliated, columnar epithelium and goblet cells with underlying smooth muscle layers. This was considered to be the cyst arising from the embryonic foregut and showing differentiation toward respiratory structures. The term 'ciliated foregut cyst of the gallbladder' is suggested here.     

Diffuse papillomatosis of the gallbladder complicated with tuberculosis

A rare case of diffuse papillomatosis of the gallbladder complicated with tuberculosis is reported. The mucosa of the gallbladder displayed a diffuse papillary pattern composed of excrescences that varied in size and height. The proliferative glands contained many Paneth cells, and the diffuse papillomatosis appeared to be derived from metaplastic-type epithelium. Tuberculous granulomas were observed in the serous layer of the gallbladder. The relationship between diffuse papillomatosis and tuberculosis of the gallbladder is discussed.     

Abnormalities of the gallbladder,clinical effects

The aim of this review of the literature was to present and discuss the anatomical and embryological basis of congenital abnormalities of the gallbladder, based on a case of volvulus. In the rare cases of ectopic gallbladder, diagnosis of a biliary disease could be difficult. In such cases surgery can also be dangerous, especially when it is associated with abnormalities of the intra-hepatic biliary and vascular tree. This study, based on the embryology of the extra hepatic bile duct, focused on the most frequent gallbladder abnormalities to keep them in mind.     

胆囊壁的神经分布及其临床意义

用乙酰胆碱脂酶(AChE)组化法和镀银法,在光、电镜下观察了10条犬和5例人标本胆囊壁的神经分布.胆碱能神经的分布在胆囊肝面和游离面的颈、体、底六区无明显区别.胆囊壁内有丰富的神经终末分布,可分为环型、膨大型和游离型三型.电镜下 AChE 反应产物见于核膜、细胞膜、轴突膜、树突膜、游离核糖体和粗面内质网上.并结合临床有关问题进行了分析讨论.     

胆囊床内血管的应用解剖

目的：为腹腔镜胆囊切除手术提供形态学基础.方法：对128例肝脏标本进行解剖,观察胆囊床内血管的位置、行程,测量其在胆囊床内的长度和直径.结果：胆囊床内血管有：（1）胆囊动脉深支及分支,占71.1%（91例）;（2）肝中静脉及其属支,占12.5%（16例）,其突入形式分①肝中静脉主干,②右前叶支、或左内叶支、或两者一起突出,③右前叶支属支、左内叶支属支、或两者一起突出3种类型;（3）肝门静脉右支及其分支,分主干和分支两类,主干占39.8%（51例）,肝门静脉右支的分支占14.8%（19例）;（4）肝门静脉左支的分支,占2.34%（3例）;（5）胆囊静脉,在胆囊附着面有小静脉与肝中静脉、肝门静脉左、右支的分支相连.结论：切除胆囊时应注意胆囊床左、右缘,以及具有肝门右切迹的病例,保护突入胆囊床内的肝中静脉及其属支,以防止出血.     

Adenoendocrine cell carcinoma of the gallbladder: A histochemical and immunohistochemical study

A case of adenoendocrine cell carcinoma of the gallbladder with adenomucous cells and neuroendocrine cells is report- ed. A histochemical and immunohistochemical study revealed that the primary tumor in the gallbladder was composed of mucus-secreting and/or argyrophil cells. Furthermore, the tumor showed a positive reaction to carcinoembryonic antigen (CEA) in all tumor cells, to chromogranin A and cytokeratin in many tumor cells, to endocrine granule constituent (EGC) in some tumor cells, and to serotonin and somatostatin in a few tumor cells. In addition, a few mucous cells showed argyrophilia and EGC-positivity in their cytoplasms. This case suggests that the adenoendocrine cell tumor is derived from endodermal stem cells as a result of bidirectional (exocrine and endocrine) differentiation.