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Gallbladder Pathology Online

Macroscopic examination and  dissection of the gallbladder

Dr Sampurna Roy MD  

 

Cholecystectomy specimens are commonly received in most general histopathology laboratories.

They are usually removed for the treatment of chronic cholecystitis and cholelithiasis.

If the composition of the gall stones needs to be assessed, this can be done by X-ray spectrometric analysis.

Carcinoma of the gallbladder may be a chance finding in cholecystectomy specimens removed for apparently non-specific cholecystitis.

When the diagnosis of carcinoma of the gall bladder or bile ducts is made clinically the tumour is usually advanced and inoperable.

Attempts at curative surgery therefore require radical operations with partial hepatectomy. 

Most gallbladders are received fixed in formalin, incised but not fully opened and everted, or (particularly in the early days of laparoscopic cholecystectomy) in multiple pieces.

Macroscopic examination includes inspection of the mucosa cleaned of all calculous debris, and examination of any included calculi to identify them as mixed, pigment, or cholesterol stones.

A description usually includes three dimensions and wall thickness, the presence or absence of a cystic lymph node, plastic clips on the neck, and whether the gall bladder was received opened or unopened, with or without stones or stone debris.

Comments should be made about any anatomical variation, ulcers or tumours.

The presence of cholesterolosis is easy to recognize macroscopically.

 

           

Three sections are usually taken from routine gallbladder specimens -

 1) Neck 2) Body and 3) Fundus.

Additional sections are taken from any visible pathology.

Sections are taken from cystic duct and lymph nodes if they appear grossly abnormal or if the gallbladder contains tumour.  

In case of suspected carcinoma in situ, the entire specimen is embedded ( "swiss roll method").

 

( Korean J Pathol. 2013 Dec;47(6):519-525.
http://dx.doi.org/10.4132/KoreanJPathol.2013.47.6.519)

 

Further reading:

Do we need histology for a normal-looking gallbladder?

Incidental gallbladder carcinoma: value of routine histological examination of cholecystectomy specimen

A selective approach to histopathology of the gallbladder is justifiable

Albores-Saavedra J, Henson DE, Klimstra DS. Tumors of the gallbladder, extrahepatic bile ducts, and ampulla of Vater. Washington, DC: Armed Forces Institute of Pathology; 2000.

Mills SE, Carter D, Greenson JK, Reuter VE, Stoler MH. Sternberg's diagnostic surgical pathology. Philadelphia: Lippincott Williams & Wilkins; 2010.

Rosai J. Rosai and Ackerman's surgical pathology. 10th ed. New York: Mosby Elsevier; 2011.

 

 

 

Dr  Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

 

 

 

          

 

 

 

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