Department of Pathology, Baptist Hospital of Miami, Miami, FL, USA.
Am J Clin Pathol. 2012 Sep;138(3):374-6. doi: 10.1309/AJCPB0ZTXXIF6MOF.
When dysplasia is identified in a gallbladder, many experts recommend submission of the entire gallbladder for histologic examination. We sought to determine if this practice could be justified. We reviewed 16,611 gallbladder resections over an 8-year period, and identified 17 cases of carcinoma (15 primary and 2 metastatic), 9 cases of high-grade dysplasia, 16 cases of low-grade dysplasia, and 81 cases with atypia, not otherwise specified (NOS). Sixteen (94%) of 17 adenocarcinomas were identified and sampled on the initial gross inspection, and the remaining case was identified and sampled on review of the gross specimen. None of the high- or low-grade dysplasias were identified on gross examination, but all were identified as atypical on the initial slide submitted and correctly graded with the submission of 4 additional slides. Eight (89%) of 9 high-grade, 6 (38%) of 16 low-grade, and 1 (1%) of 81 atypia, NOS, cases were subsequently entirely submitted without identification of any new lesion. We conclude that for cases of dysplasia and atypia, NOS, review of the gross specimen and submission of up to 4 additional sections identify all significant lesions, and submission of the entire gallbladder is not justified.
当胆囊中发现发育异常时，许多专家建议对整个胆囊进行组织学检查。我们试图确定这种做法是否合理。我们回顾了 8 年内进行的 16611 例胆囊切除术，发现了 17 例癌（15 例原发性和 2 例转移性）、9 例高级别发育异常、16 例低级别发育异常和 81 例非特指性不典型增生（NOS）。17 例腺癌中有 16 例（94%）在初次大体检查时被识别和取样，其余 1 例在大体标本复查时被识别和取样。高或低级别发育异常均未在大体检查中被识别，但所有病例在初次提交的切片中被识别为不典型，并在提交 4 个额外切片后正确分级。9 例高级别发育异常中有 8 例（89%）、16 例低级别发育异常中有 6 例（38%）和 81 例非特指性不典型增生（NOS）中有 1 例（1%）在未识别出新病灶的情况下全部提交。我们得出结论，对于发育异常和不典型增生（NOS）病例，审查大体标本并提交多达 4 个额外切片可以识别所有重要病变，因此不需要提交整个胆囊。
