Gallbladder

Author: Mikael Häggström

Common requests

• Cholecystitis
• Gallbladder polyp

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

• Minimal depth
• (Moderate depth)
• ((Comprehensive))

Other legend

<< Decision needed between alternatives separated by / signs >>
{{Common findings / In case of findings}}
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Gross processing

Cholecystectomy grossing

• Describe the serosa (smooth and intact versus disrupted, adhesions, inflammation, tumor implants, necrosis, porcelain).
• (Inspect the adventitia (the roughened juxtahepatic surface), where disruptions are generally iatrogenic and optional to report.)
• Cut off the cystic duct margin and submit
• Look for any cystic duct lymph node, describe and submit if present
• Open the gallbladder longitudinally on the serosal surface. Do not open along the adventitia.
• (Estimate the amount of bile.)
• {{Estimate the number and describe gallstones.}}
• Describe the mucosa (such as velvety, granular, trabeculated, and/or with cholesterol stippling)

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  Cholesterol stippling (cholesterolosis): yellow streaks of cholesterol deposition, a frequent incidental finding.

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  Trabeculated gallbladder.

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  Gallbladder polyp

• Look for any gallbladder polyps or tumors. Tumors will usually be hard.
• Open the spiral neck, and look for lesions and gallstones therein
• Cut through the wall, and look for any tumors or Rokitansky-Aschoff sinuses
• Look for gallstones in the container

Gross report

((Labeled - gallbladder. The specimen is received in formalin and consists of a resected)) {{ previously opened? focally disrupted (on the juxtahepatic avdentitial surface only)? edematous?}} gallbladder measuring __ cm in length and __ cm in maximum diameter. The serosa is {{(mottled) tan / pink / red (generally combinations thereof) and}} smooth {{/ with patchy adhesions}} Upon opening, the lumen contains ((__ [[volume in cc/cm3]])) green {{/ brown / blood-tinged / yellow-white and chalky / clear colorless viscid / sludge-like / thick}} bile {{and (approximately) __ (number) / multiple black / brown / green / yellow / tan / white (generally combinations thereof) irregular / multifaceted / spiculated / ovoid / mulberry-like / barrel-like gallstones measuring up to __ cm in greatest dimension.}} The mucosa is green {{/ tan / yellow-red / brown / pink}} and velvety {{/ granular / trabecular with diffuse cholesterol stippling?}} The spiral neck is patent {{/ obstructed by one additional similar gallstone measuring __ cm}}. The wall measures up to __ cm in thickness. {{ Rokitansky-Aschoff sinuses are present within the fundus. There is a __ (color) cystic duct lymph node present measuring __ cm in greatest dimension. }} ((Representative sections are submitted for microscopic examination in __ cassette(s). ))

Rifts on the adventitial side that are consistent with surgical trauma need mentioning only in tumor cases.

Carcinoma

Pathology trainees that find an unsuspected tumor should generally notify a senior before continuing.

• State whether the gallbladder is intact when you received it.
• Ink the surgical margin (adventitial surface).
• Ink the cystic duct margin (lightly) and put in a separate cassette. Notify the lab to have it submitted en face
• Look for any cystic duct lymph nodes. If found, bisect and submit.
• Measure the tumor in greatest dimension and thickness and state where in the gallbladder it is located (fundus, body, etc and whether it is on the peritoneal or hepatic side).
• Measure the margin to the cystic duct resection
• State all other abnormalities including stones, Rokitansky-Aschoff sinuses etc.

Take sections from:

• Cystic duct margin, en face
• Cystic duct lymph node if present
• Sections of tumor, full thickness
• Sections of unaffected gallbladder

Autopsy grossing

Gross pathology of gallbladder carcinoma, with a prominent nodule.

The gallbladder and biliary tract may be cut open from either end:

• Starting from the gallbladder: Cut the gallbladder open and from there dissect the cystic duct and common bile duct through the ampulla of Vater.
• Starting from the duodenum: Identify the ampulla of Vater, possibly by bile flow when squeezing the gallbladder. Dissect the common bile duct, cystic duct and thereafter the gallbladder. If the cystic duct is difficult to find, transverse cuts may be performed at its presumed location.
• In the gallbladder, inspect the contents and the appearance of the wall. Look mainly for signs of carcinoma. Optionally, estimate the volume of bile therein.
• In the biliary tract, look mainly for stones and stenosis.

Further information: Autopsy

Fixation

Generally 10% neutral buffered formalin.

  See also: General notes on fixation

Microscopic evaluation

Look at least at the epithelial lining, for atypia and inflammation (such as edema and inflammatory cells, Further information: cholecystitis ).

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  Acute cholecystitis.

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  Histopathology of gallbladder carcinoma, with marked nuclear pleomorphism

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  Look in the gross report for gallstones, which is generally reported or commented in the microscopy diagnosis as well.

Other findings

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  Report a substantial amount of foam cells within lamina propria, conferring a diagnosis of cholesterolosis.

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  Liver tissue in the periphery of a gallbladder resection, does not need to be reported.

Report

Example:

(Gallbladder, resection:) Gallbladder with no significant histopathologic changes

In cholecystitis:

(Gallbladder, cholecystectomy:) <<Acute and/or chronic>> cholecystitis. {{Cholelithiasis.}}

For cancers, generally include a synoptic report, such as per College of American Pathologists (CAP) protocols at cap.org/protocols-and-guidelines.

  See also: General notes on reporting

Main page

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