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    Non-neoplastic polyps of the gallbladder: A clinicopathologic analysis of 447 cases
    (2020) Taşkın, Orhun; Bellolio, Enrique; Dursun, Nevra; Erbarut Seven, İpek; Roa, Juan C.; Araya, Juan C.; Villaseca, Miguel; Tapia, Oscar; Vance, Courtney; Saka, Burcu; Balcı, Serdar; Bağcı, Pelin; Losada, Hector; Sarmiento, Juan; Memis, Bahar; Pehlivanoğlu, Burçin; Baştürk, Olca; Reid, Michelle D.; Koshiol, Jill; Cheng, Jeanette; Kapran, Yersu; Adsay, Volkan
    There is no systematic histopathologic analysis of non-neoplastic polyps in the gallbladder. In this study, in addition to a computer search for cases designated as "polyp," a systematic review of 2533 consecutive routinely sampled archival and 203 totally submitted prospective cholecystectomies were analyzed for >2?mm polyps (cut-off was based on radiologic sensitivity). A total of 447 non-neoplastic polyps were identified. The frequency was 3% in archival cases and 5% in totally submitted cases. Only 21 (5%) were ?1?cm. The average age was 52 years, and the female to male ratio was 3.1. Two distinct categories were delineated: (1) injury-related polyps (n=273): (a) Fibro(myo)glandular polyps (n=214) were small (mean=0.4?cm), broad-based, often multiple (45%), almost always (98%) gallstone-associated, and were composed of a mixture of (myo)fibroblastic tissue/lobular glandular units with chronic cholecystitis. Dysplasia seen in 9% seemed to be secondary involvement. (b) Metaplastic pyloric glands forming polypoid collections (n=42). (c) Inflammatory-type polyps associated with acute/subacute injury (11 granulation tissue, 3 xanthogranulomatous, 3 lymphoid). (2) Cholesterol polyps (n=174) occurred in uninjured gallbladders, revealing a very thin stalk, edematous cores devoid of glands but with cholesterol-laden macrophages in 85%, and cholesterolosis in the uninvolved mucosa in 60%. Focal low-grade dysplasia was seen in 3%, always confined to the polyp, unaccompanied by carcinoma. In conclusion, non-neoplastic polyps are seen in 3% of cholecystectomies and are often small. Injury-related fibromyoglandular polyps are the most common. Cholesterol polyps have distinctive cauliflower architecture, often in a background of uninjured gallbladders with cholesterolosis and may lack the cholesterol-laden macrophages in the polyp itself. Although dysplastic changes can involve non-neoplastic polyps, they do not seem to be the cause of invasive carcinoma by themselves.
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    Poorly cohesive cell (diffuse-infiltrative/signet ring cell) carcinomas of the gallbladder: Clinicopathological analysis of 24 cases identified in 628 gallbladder carcinomas
    (W B Saunders Co-Elsevier Inc, 2017) Tuncel, Deniz; Carlos Roa, Juan; Carlos Araya, Juan; Bellolio, Enrique; Villaseca, Miguel; Tapia, Oscar; Jang, Kee-Taek; Quigley, Brian; Saka, Burcu; Baştürk, Olca; Sarmiento, Juan; Losada, Hector F.; Patel, Samip; Reid, Michelle D.; Memiş, Bahar; Adsay, Volkan
    Signet ring cell carcinoma is an extremely rare type of gallbladder carcinoma: In the gastrointestinal system, carcinomas with single-cell or cord-like infiltration, previously called "diffuse-infiltrative" type or "signet ring cell," are now designated as "poorly cohesive cell" (PCC) type (regardless of with/without signet ring cells) in the World Health Organization 2010 classification. Six hundred twenty-eight primary invasive gallbladder carcinomas were reviewed for the PCC pattern. Twenty-four cases in which classical PCC pattern constituted greater than 50% of the tumor were included in the study. The mean age was 63 (range, 44-84) years. A strong female predominance was present (female/male ratio, 6.3 versus 3.9 for all gallbladder carcinomas). Most cases (79%) had advanced carcinoma (pT3+) in comparison with 51% of usual carcinomas (P < .01). All cases (100%) showed at least focal signet ring morphology (intracytoplasmic mucin), and this was predominant in 50%. Twelve cases (50%) demonstrated a focal invasive glandular component of the usual type. Overlying focal high-grade dysplasia was identified in 11 (46%). Due to block loss, immunohistochemistry could be performed in only 5 cases and revealed a profile similar to upper gastrointestinal carcinomas CK7++/CK20-+/CDX2+-/p53+. E-cadherin was decreased in the PCC component of all cases. The clinical course appeared to be more aggressive than ordinary gallbladder. carcinomas, with median survival of 3.3 months versus 11.8 months, which did not reach statistical significance (P = .06 by log-rank test). In conclusion, PCC carcinoma originating in the gallbladder should be kept in mind for the differential diagnosis of disseminated poorly differentiated carcinomas in the abdomen.