Cellular Phenotypes in Gallbladder Dysplasia: Diagnostic Significance and Clinical Associations in an Analysis of 318 Cases
Pelin Bagci, Burcu Saka, Ipek Erbarut, Nevra Dursun, Olca Basturk, Juan Carlos Roa, Oscar Tapia Escalona, Hector Losada, Kee-Taek Jang, So Yeon Kong, Alton B Farris, Volkan Adsay. Emory University, Atlanta, GA; Memorial Sloan-Kettering Cancer Center, New York, NY; PU, Santiago, Chile; Frontera University, Temuco, Chile; SMC, Seoul, Korea
Background: The literature on the cellular patterns of high-grade dysplasia (HGD) of the gallbladder (GB) is highly limited.
Design: 318 cases with conventional (non mass-forming) HGD, 189 with accompanying invasion, were analyzed.
Results: Four distinct cell types were recognized, often occurred in a mixture: I) Biliary-cuboidal, identified in 90%, predominant in 69%, characterized by monotonous cells, round centrally/suprabasally located nuclei, cherry-red macronucleoli, and abundant cytoplasm showing either clear-cell (13%), chromophobe-like (8%) and oncocytoid (3%) features. II) Biliary-pencillate, identified in 48%, predominant in 14%, crowded thin elongated nuclei with no nucleolar prominence, minimal amount of cytoplasm, creating an overall basophilia recapitulating the pencillate cells of GB epithelium. III) Gastric, identified in 48% and predominant in 10%, abundant apical pale cytoplasm, basally located mildly enlarged nuclei. IV) Intestinal, identified in 13%, predominant in 6%, resembling adenomatous epithelium of GI tract (not defined by goblet cells, which can occur in any type). Associations: Pencillate type appeared to be the least aggressive (lowest rate of invasion, 54%, and longest 5-yr, 60%), going along with its relatively bland cytology and organized appearance. Biliary-cuboidal type had the highest degree of atypia but had intermediate aggressiveness. In contrast, the metaplastic phenotypes, intestinal and gastric, were more aggressive (associated with invasion in 70 and 67 % and with 5-yr of 49, and 50% respectively) despite their often subtle and difficult to recognize appearance, especially for the gastric type.
Conclusions: In addition to the ordinary biliary cuboidal cell HGD characterized by macronucleoli and abundant cytoplasm with clear-cell, chromophobe or oncocytoid features, a previously unrecognized pattern, biliary-pencillate type is elucidated in this study. More importantly, metaplastic phenotypes, gastric (foveolar) and intestinal akin to those recently recognized in other segments of GI tract (such as the stomach, by Lauwers et al.) also occur in the GB, and appear to be more aggressive despite their lesser degree of cytologic atypia.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 203, Tuesday Morning