Southern Medical Journal:
Special Sections: Letters to the Editor
Lin, Mercury Y. MD; Shikle, James F. MD
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)
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).
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
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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