Jump To

Gallbladder

Background

Normal appearance of gallbladder is a smooth, sac-like organ with sphincter at the neck and glistening serosa. It is filled with green-brown bile and lined with a folded mucosa.^1-5

Show more

Gallbladders are mostly commonly removed as treatment of chronic cholecystitis with presence of gallstones (cholelithiasis) detected on imaging. Tumours occur infrequently but must be considered in reporting. Primary and secondary carcinomas need to be excluded in final diagnosis.

Biliary tract carcinomas are treated with a range of resections dependent on their location. Intrahepatic cholangiocarcinomas (within the liver) require a segmental resection liver. Perihilar cholangiocarcinoma (near the junction of right and left hepatic ducts) may require resection of the gallbladder, extrahepatic bile ducts and lymph nodes with or without a lobe of the liver. A Kausch-Whipple’s resection (pancreatoduodenectomy) may be required for tumours located close to the Ampulla of Vater. Segmental bile duct resections are possible but less common. Refer to cut-up instructions for liver and pancreas for further information.

Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

Fresh tissue received

No
- Non-routine fixation (not formalin), describe.

Yes
- Special studies required, describe.
- Ensure samples are taken prior to fixation.

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External Inspection

Orientate and identify anatomical features of the specimen: cystic duct, body, fundus and gallbladder bed margin.

Photograph the intact specimen if required.

Describe the following features of the specimen:

Procedure

Record as stated by the clinician.

Simple cholecystectomy
Radical cholecystectomy
Other, describe

Anatomical components included (more than one may apply) and dimensions (mm)

Describe and measure the anatomical components present.

Gallbladder, in two dimensions
Cystic duct
Bile duct, length
Liver with gallbladder bed (for tumour), in three dimensions -see liver protocols also
Other organs/tissue present, describe and measure (refer to relevant specimen protocol for more detail)

Specimen integrity

Intact
- Unopened
- Open
Disrupted
- Number of pieces received

Outer surface

(more than one may apply)

Unremarkable
Congested
Adhesions
Fibrinopurulent exudate
Fibrotic
Nodular
Perforation
Tumour present

Dissection

On arrival in laboratory, open the gallbladder longitudinally along the serosal surface, preserving the cystic duct and gallbladder bed margins. This will allow to the specimen to fix adequately before processing.

Internal Inspection

Describe the internal appearance including the following items:

Gallbladder wall

Maximum thickness (mm)

Gall bladder contents (if not bile)

Pus
Mucus

Gallstones (calculi)

None present
Present
- Number
- Range of sizes (mm)

Colour of gallstones

Pigmented green-black
Yellow cholesterol
Mixed

Site of gallstones

In bile
Embedded in mucosa
Impacted in neck/cystic duct

More detail

Note the presence or absence of gallstones, remove any that are present and wash. Stones may be fragmented during laparoscopic surgery and be gravel-like pieces in the bile. Look for stones embedded in the mucosa and note any impacted in the neck or cystic duct. A stone may be submitted for chemical analysis in some laboratories.

Mucosa

Velvety
Roughened
Eroded/ulcerated
Fibrotic/trabeculated

Tumour, if present

Number of tumours

Number; if more than one tumour, designate and describe each tumour separately

Tumour size (mm)

Maximum dimension
Other dimensions

Tumour location

(more than one may apply)

Cystic duct
Neck
Body
Fundus

Surface involved

Serosal aspect
Gallbladder bed/hepatic aspect
Not assessable

Tumour appearance

Polyp
Nodule
Diffuse thickening
Ulcer

Distance from margins (mm)

Distance of tumour to closest margin, specify margin (gallbladder bed margin or cystic duct margin)

Lymph nodes

Retrieved from resection specimen

Describe site(s)
Number retrieved

Separately submitted

For each container, record specimen number and designation
Collective size of tissue in three dimensions (mm)
Number of grossly identified lymph nodes submitted
Maximum diameter of each (mm)

Serially section the specimen transversely at 3-4mm intervals

Photograph the lesion and the cut surface of the tumour if applicable.

Note photographs taken, diagrams recorded, ink or marks used for identification.

Processing

Dissect the specimen further and submit sections for processing according to the diagram provided.

Sections of cystic duct margin should be identified in a separate cassette or marked with ink. A small cystic duct lymph node is often present and should be submitted for processing if located.

Unremarkable gallbladder

Submit representative transverse sections, at least one section each of:

Fundus
Neck or body
Cystic duct margin

Inflamed gallbladder

Submit representative transverse sections including serosa of:

Fundus
Neck or body
Cystic duct margin
Any obvious lesions

Gallbladder with tumour(s) apparent macroscopically

Submit transverse sections of entire tumour demonstrating:

Deepest extent of invasion
Distance to gallbladder bed and/or cystic duct margin

Submit representative transverse sections from:

Cystic duct margin
Non-neoplastic areas of fundus and neck/body

Submit all lymph nodes for processing.

Record details of each cassette.

An illustrated block key similar to those provided below may be useful.

Block allocation keys

Non tumour

Cassette id	Site	No. of pieces
A	Cystic duct margin, neck/body, fundus

Tumour

Cassette id	Site	No. of pieces
A	Cystic duct margin
B	Tumour, deepest point of invasion
C	Tumour with gallbladder bed margin (if applicable)
D	Tumour with cystic duct margin (if applicable)
E-F	Tumour, representative sections
G	Background mucosa
H	Lymph nodes

Acknowledgements

Dr Ian Brown for his contribution in reviewing and editing this protocol.

References

Feakins R, Campbell F, Mears L, Moffat C, Scott N and Allen D. Tissue pathways for gastrointestinal and pancreatobiliary pathology, The Royal College of Pathologists, London, 2009.
Lester SC. Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010.
Allen DC and Cameron RI (eds). Histopathology Specimens: Clinical, pathological and laboratory aspects. Springer-Verlag, London, 2012.
Odze RD. Surgical pathology of the GI tract, liver, biliary tract and pancreas. Goldblum J. Saunders Elsevier, Philadelphia, 2009.
Ishak KG, Goodman ZD and Stocker JT. Atlas of Tumour Pathology. Tumours of the Liver and Intrahepatic Bile Ducts. 3rd series, Fascicle 31. Armed Forces Institute of Pathology, Washington, 2001.