[1759] Growth Patterns of High-Grade Gallbladder Dysplasia: Clinicopathologic Associations and Diagnostic Implications in an Analysis of 318 Cases

Pelin Bagci, Burcu Saka, Ipek Erbarut, Nevra Dursun, Olca Basturk, Juan C 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 diagnosis of dysplasia in the gallbladder (GB) is a well known challenge. Meanwhile, there is virtually no data on the growth patterns of high-grade dysplasia (HGD) of GB, and their diagnostic and clinical significance.
Design: 318 cases with unequivocal conventional (non mass-forming) HGD, 189 with accompanying invasion, were analyzed.
Results: Various growth patterns were recognized and often occurred in a mixture: Flat/ondulating in 82%, tubular- 66%, micropapillary/tufting-52%, denuding/clinging-19%, tall-papillary-22%, urothelial-like 1%, acantolytic-1%. When analyzed based on the predominant pattern(also see table): Tall papillary was commonly associated with invasion (88%; p= 0.001) and the worst clinical outcome, with 5-yr survival of 25%. Denuding/clinging had a similar trend but not statistically significant. In contrast, flat type had the best survival (66%, p=0.002). Hyalinizing cholecystitis ("incomplete" porcelain) cases (n=35) typically had either denuding/clinging or flat patterns, and almost never tall papillary or tubular. Tubular pattern was often difficult to distinguish from invasion, in particular, the foamy-gland, foveolar and attenuated cell variants.

Variables (Units)Denuding (n=12)Flat (n=190)Glandular/Tubular (n=51)Micropapillary (n=32)Tall Papillary (n=33)p-value
Age, mean (±SD), year68.2 (7.4)59.7 (14.9)66.7 (12.9)62.6 (11.4)68.0 (9.8)0.001
Male / Female2 (17%) / 10 (83%)37 (21%) / 142 (79%)8 (18%) / 35 (78%)8 (27%) / 22 (73%)9 (27%) / 24 (73%)0.1139
Presence of Invasion10 (83 %)91 (48%)38 (75%)21 (66%)29 (88%)<0.0001
Invasion Size, mean (±SD), mm28.9 (16.1)32.0 (23.0)15.7 (14.4)24.8 (19.2)22.4 (17.0)0.0053
Stage of Invasive Tumor
T1010 (12%)4 (12%)2 (10%)3 (11%)0.9223
T28 (80%)41 (50%)20 (59%)10 (48%)14 (50%)
T32 (20%)31 (38%)10 (29%)9 (43%)11 (39%)
Survival Rates
1-year50%76 %88%69%68%0.002
Median Survival (mos)18N/AN/AN/A19%

Conclusions: HGD of GB occurs in various growth patterns. Tall papillary examples are significantly more commonly associated with higher frequency of invasive carcinoma and adverse outcome. Clinging/denuding pattern also appears to be aggressive, is common in hyalinizing cholecystitis and needs to be carefully searched for. Tubular examples often mimic invasive carcinoma but are more indolent in behavior. Recognition of these patterns would allow accurate diagnosis and guide more targeted pathologic examination and prognostication.
Category: Pancreas

Tuesday, March 5, 2013 2:30 PM

Proffered Papers: Section F, Tuesday Afternoon


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