Gallbladder
Author:
Mikael Häggström [note 1]
Contents
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.
Take sections from:
- Cystic duct margin, enface
- Cystic duct lymph node if present
- Sections of tumor, full thickness
- Sections of unaffected gallbladder
Autopsy grossing
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.
Cholesterolosis (yellow streaks of cholesterol deposition) is a frequent incidental finding.[1]
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))
- Other legend
<< Decision needed between alternatives separated by / signs >>
{{Common findings / In case of findings}}
[[Comments]]
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((Labeled: gallbladder. The specimen is received in formalin and consists of a resected)) gallbladder ((that measures __ cm in length and 3.0 cm in maximum diameter)) / (is of regular size). (The serosa is {{mottled tan-red and}} smooth.) Upon opening, the lumen contains ((approximately __ ml [[or cc]] of)) {{green viscid}} bile {{and __ yellow-brown, mulberry-like gallstones measuring up to __ cm}}. (The mucosa is green and velvety {{with diffuse cholesterol stippling}}. The spiral neck is patent.}} The wall <<is thin / ((measures up to __ cm in thickness)). {{A tan-pink cystic duct lymph node is present measuring __ cm in greatest dimension.}} (Representative sections are submitted for microscopic examination in one cassette.)
Notes
- ↑ 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.
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References
Image sources