Gallbladder

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Author: Mikael Häggström [note 1]

Common requests

Gross processing

Cholecystectomy grossing

  • Describe the serosa (smooth and intact, adhesions, inflammation, tumor implants, necrosis, porcelain)
  • 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 adventitia
  • Estimate the amount of bile
  • Estimate the number and describe gallstones
  • Describe the mucosa (velvety, granular, trabeculated, cholesterol stippling etc)
  • Look for polyps and tumors. Tumors will usually be hard.
  • Open the spiral neck, look for lesions and gallstones
  • Cut through the wall, look for tumors, Rokitansky-Aschoff sinuses
  • Look for gallstones in the container

Carcinoma

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

  • Ink the surgical margin (adventitial surface). State whether the gallbladder is intact when you received it.
  • Ink the cystic duct margin (lightly) and but in separate cassette- write “enface” on the side of the cassette
  • Look for a cystic duct lymph node(s), 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 how far from the cystic duct margin of resection
  • State all other abnormalities including stones, Rokitansky-Aschoff sinuses etc.

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.

Common findings

Report if incidentally discovered:

Report

Comprehensiveness

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

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

{{Common findings / In case of findings}}

Template:Gallbladder report

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Talwar, OP; K.C., Geetika (2014). "Histomorphological changes in gall bladder diseases and its association with helicobacter infection ". Journal of Pathology of Nepal 4 (8): 617–622. doi:10.3126/jpn.v4i8.11607. ISSN 2091-0908. 
    - "Figures - available via license: CC BY 4.0"

Image sources