Abstract:
Serrated lesions outside the low digestive tract are scarce, with only two traditional serrated adenomas (TSA) reported in the gallbladder, with limited information about the serrated pathway outside the colon. Our case was an incidental finding in a patient undergoing surgery to treat a cholecystitis, when a polypoid lesion was observed. The epithelium formed gland structures with ectopic crypts, serrated slits and eosinophilic cytoplasm. MUC4 and MUC5A were positive, but mismatch repair proteins (MSI) retained nuclear staining. BRAF showed a not mutated profile and NRAS/KRAS was inconclusive due to the absence of remaining tissue. MSI and CpG island (CIMP), the most common genetic hallmarks of the serrated pathway, have been proven in gallbladder carcinomas, although serrated polyps are not recognized as premalignant precursors. Hereby we report one TSA of the gallbladder without the usual genetic drivers. A larger evidence is needed to improve the diagnosis and management.
摘要:
低消化道外的锯齿状病变很少,胆囊中只有两个传统的锯齿状腺瘤(TSA),关于结肠外锯齿状通路的信息有限。我们的病例是在接受手术治疗胆囊炎的患者中偶然发现的,当观察到息肉样病变时。上皮形成有异位隐窝的腺体结构,锯齿状狭缝和嗜酸性细胞浆。MUC4和MUC5A呈阳性,但错配修复蛋白(MSI)保留了细胞核染色。BRAF显示未突变的概况,并且由于不存在剩余组织,NRAS/KRAS是不确定的。MSI和CpG岛(CIMP),锯齿状途径最常见的遗传标志,已经在胆囊癌中得到证实,虽然锯齿状息肉不被认为是癌前病变的前体。因此,我们报告了一种没有通常遗传驱动因素的胆囊TSA。需要更大的证据来改善诊断和管理。