Adenomyomatous hyperplasia of the gallbladder with perineural invasion: Revisited

Jorge Albores-Saavedra, Brent Keenportz, Pablo A. Bejarano, Alan A Z Alexander, Donald E. Henson

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Abstract

We report 9 examples of segmental adenomyomatous hyperplasia of the gallbladder with perineural invasion. Five patients were women and 4 men. Their ages ranged from 49 to 81 years (mean age 64 y). Eight patients had gallbladder calculi. The original pathologic diagnosis of adenocarcinoma was made in 5 patients and of "adenoma malignum" in one. Six patients are diseasefree for 2 to 11 years following cholecystectomy, 1 patient died of unrelated causes and 2 were lost to follow-up. Histologically 2 types of adenomyomatous hyperplasia were recognized. The first one characterized by numerous Rokitansky-Aschoff sinuses (RASs) was accompanied by smooth muscle hyperplasia and an expanded subserosal layer containing numerous nerve trunks (6 cases). The second type was characterized by an extensively fibrotic gallbladder wall with numerous RASs but with few or no smooth muscle bundles and an expanded subserosal layer containing abundant nerve-trunks (3 cases). Perineural (7 cases) and intraneural invasion (2 cases) was identified only in the subserosal layer. The lack of p53 reactivity and the very low MIB-1-labeling index provide additional support to the non-neoplastic nature of the lesion. The pseudoinvasive pattern of the RASs, reactive epithelial atypia, and the perineural and intraneural invasion probably contributed to the erroneous diagnosis of adenocarcinoma or "adenoma malignum." The mechanism by which the epithelial structures "invaded" the perineural spaces and the nerves is unclear. We favor the hypothesis that the migration of the benign glandlike structures into the nerves is related to the production of chemotactic factors or signaling substances and the activation of cell receptors.

Original languageEnglish
Pages (from-to)1598-1604
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume31
Issue number10
DOIs
StatePublished - Oct 1 2007

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Keywords

  • Adenomyomatous hyperplasia
  • Gallbladder
  • Perineural invasion
  • Reactive atypia

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Albores-Saavedra, J., Keenportz, B., Bejarano, P. A., Alexander, A. A. Z., & Henson, D. E. (2007). Adenomyomatous hyperplasia of the gallbladder with perineural invasion: Revisited. American Journal of Surgical Pathology, 31(10), 1598-1604. https://doi.org/10.1097/PAS.0b013e31804fa10e