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.(AU)
Las lesiones serradas no suelen localizarse fuera del tracto digestivo bajo, con solo 2 adenomas serrados tradicionales (TSA) descritos. Por ello, la información sobre la vía serrada fuera del colon es limitada. Nuestro caso trata de un hallazgo incidental en un paciente al que se le realizó una colecistectomía y en el que se observó una lesión polipoide. Esta formaba estructuras glandulares con criptas ectópicas, serración y citoplasma eosinófilo. MUC4 y MUC5A eran positivos, pero las proteínas implicadas en la inestabilidad de microsatélites (MSI) conservaban tinción nuclear. BRAF no estaba mutado y NRAS/KRAS no fue concluyente. La MSI y la metilación de CpG (CIMP) son las vías oncogénicas más comunes de la vía serrada y se ha demostrado en carcinomas de vesícula biliar. Sin embargo, los pólipos serrados no se reconocen como precursores premalignos. Nuestro caso trata de un adenoma serrado tradicional de vesícula biliar sin rasgos genéticos habituales. Se necesita mayor casuística en la literatura.(AU)
Subject(s)
Humans , Male , Aged , Gallbladder , Adenoma , Incidental Findings , Cholecystectomy , Polyps , Inpatients , Physical ExaminationABSTRACT
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.
