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Southern Medical Journal:
doi: 10.1097/SMJ.0b013e3181a90285
Special Sections: Letters to the Editor

To Pick a ‘Bone’ with the Gallbladder

Lin, Mercury Y. MD; Shikle, James F. MD

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Medical Corps, United States Navy; Naval Medical Center San Diego; San Diego, CA (Lin)

Medical Corps, United States Army; Eisenhower Army Medical Center; Fort Gordon, GA (Shikle)

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To the Editor:

The case report by Nelson and Khan1 of bone metaplasia in the gallbladder was very insightful on this uncommon histologic finding of unknown clinical significance. We would like to contribute a similar case from our surgical pathology archive.

A 52-year-old, obese female (body mass index of 37.6 kg/m2), with a history of ulcerative colitis in remission, presented acutely to the Naval Medical Center San Diego Emergency Department after waking up from sleep with intense right upper quadrant pain. She reported moderate nausea, but no emesis. She was afebrile at presentation, with stable vital signs and unremarkable screening lab work. Physical exam demonstrated a positive Murphy sign and ultrasonography revealed a 1.5 cm cholelith. A laparoscopic cholecystectomy was performed with an uneventful postoperative course.

The surgical specimen consisted of a 6.5 × 3.2 × 1.2 cm gallbladder with 4 intraluminal calculi (largest calculus measuring 1.5 cm in greatest dimension) and an average wall thickness of 0.3 cm. A 0.2 × 0.2 cm polypoid projection was noted in the distal portion of the fundus. Histologic findings are diagnostic for chronic cholecystitis with cholelithiasis, cholesterolosis and a cholesterol polyp in the distal fundus with associated metaplastic bone formation (Figs. 1 and 2).

Fig. 1
Fig. 1
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Fig. 2
Fig. 2
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In our review of the literature, we noted only one other report of osseous metaplasia in a gallbladder cholesterolpolyp by Ortiz-Hidalgo and Baquera-Heredia.2 Since our patient’s cholecystectomy from three years prior, she has received further treatment in weight management and continues to be followed for her inflammatory bowel disease, which has remained in remission. In summary, bony metaplasia in the gallbladder is a peculiar microscopic finding and can be seen in association with cholesterol polyps.

Mercury Y. Lin, MD

Medical Corps, United States Navy

Naval Medical Center San Diego

San Diego, CA

James F. Shikle, MD

Medical Corps, United States Army

Eisenhower Army Medical Center

Fort Gordon, GA

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References

1. Nelson JJ, Khan AG. A case of bone metaplasia of the gallbladder epithelium. South Med J 2009;102:322–324.

2. Ortiz-Hidalgo C, Baquera-Heredia J. Osseous metaplasia in polypoid cholesterosis. Am J Surg Pathol 2000;24:895.

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Section Description

Letters to the Editor are welcomed. They may report new clinical or laboratory observations and new developments in medical care or may contain comments on recent contents of the Journal. They will be published, if found suitable, as space permits. Like other material submitted for publication, letters must be typewritten, double-spaced, and must not exceed two typewritten pages in length. No more than five references and one figure or table may be used. See “Information for Authors” for format of references, tables, and figures. Editing, possible abridgment, and acceptance remain the prerogative of the Editors.

© 2009 Southern Medical Association

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