[639] High Grade Dysplasia (Intraepithelial Neoplasia) of the Gallbladder (GB): Patterns, Cell Lineages and Clinicopathologic Associations in an Analysis of 255 Cases

Pelin Bagci, Nevra Dursun, Burcu Saka, Olca Basturk, Juan Carlos Roa, Oscar Tapia, Kee-Taek Jang, Ipek Erbarut, So Yeon Kong, Jeanette Cheng, Volkan Adsay. Emory U, Atlanta; MSKCC, New York; UFRO, Temuco, Chile

Background: Data on the morphologic spectrum and clinicopathologic associations of non-tumoral high-grade dysplasia (HGD) of the GB is highly limited.
Design: 255 cases with unequivocal HGD were analyzed. Excluded were indefinite cases, low-grade dysplasia and tumoral intraepithelial neoplasms (WHO's “adenomas” and “intracystic papillary neoplasms;" or as recently proposed, intracholecystic papillary tubular neoplasms).
Results: F/M=3. Mean age=60 (56 for non-inv, 66 for inv). Growth patterns encountered were flat (220), micropapillary/tufting (72), tall-papillary (without tumor formation; 54), denuding/clinging (47), glandular/cribriform (37). Different cell lineages that often occured in a mixture were recognized: 1.Biliary-cuboidal (223): Monotonous round cells with centrally or suprabasally located large nuclei (2-3x normal, typically >9.74µ), relatively fine chromatin, prominent nucleoli (mean 2.7µ), abundant cytoplasm (oncocytoid 19, chromophobe-like 38, or clear cell 29). 2.Biliary-pencillate (44): Crowded, thin, elongated nuclei with no nucleolar prominence, minimal cytoplasm. 3.Gastric (58): Abundant apical pale cytoplasm, basally located enlarged nuclei, open chromatin, nuclear irregularities or nucleolar prominence. 4.Intestinal (22): Reminiscent of adenomatous GI epithelium. 5.Other patterns: Squamous (2), signet-ring (2), and transitional (1). The overall frequency of encounter of the 4 main types and their clinicopathologic associations are in Table and Figure.

 Biliary Cuboidal (n=223)Biliary Pencilate (n=44)Gastric (n=58)Intestinal (n=22)p
Mean Age606163670.185
F:M3.83.84.22.20.652
Presence of invasion106(50%)15(35%)34(62%)15(79%)0.005
Size of inv, cm2.92.43.35.2<0.001
Stage of inv tm     
T17(7%)3(20%)2(6%)1(7%)
T246(49%)6(40%)20(65%)6(40%)0.380
T341(44%)6(40%)9(29%)8(53%)





Conclusions: High-grade dysplasia of the gallbladder manifests in various thus far uncharacterized patterns with different biologic characteristics. Metaplastic phenotypes appear to reflect more aggressive biology, especially the intestinal group and (to a lesser degree) the gastric ones are associated with higher frequency of larger size, advanced stage invasive carcinoma, and poorer prognosis.
Category: Gastrointestinal

Tuesday, March 20, 2012 9:30 AM

Poster Session III # 137, Tuesday Morning

 

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