Role of morphology and immunohistochemistry in the diagnosis of cryptic and occult cancer of gall bladder

Abstract

Background:To analyze the role of morphology and immunohistochemistry in the diagnosis of cryptic and occult cancers in cases of gall stone disease. Materials and Methods: A total of 125 cases of gall stone disease were analyzed. Three sections were taken from the neck, body and fundus. Additional sections were taken from all grossly abnormal areas. Immunohistochemistry was performed in cases showing atypia on histopathological examination. A panel of p53, CEA and Ki-67 were used. Results: Gall baldder cancer was detected in 5.7% of cholecystectomy specimens. The incidence of malignancy was the highest for gall bladders having inflammation with atypia followed by those with inflammation and hyperplasia; and finally inflammation with intestinal atypia. Additional sectioning and immunohistochemistry is mandatory in gall bladders having such changes to rule out an underlying malignancy. Among gall bladders having inflammation with pyloric metaplasia or inflammation alone, no suspicious lesion was noted on additional sectioning. Conclusion: Careful attention to morphological abnormalities in all cholecystectomy specimens is mandatory. In gall bladders having inflammation with or without pyloric metaplasia, taking additional sections is unnecessary.