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Mucin-containing Rokitansky-Aschoff sinuses with extracellular mucin deposits simulating mucinous carcinoma of the gallbladder.
[carcinoma of the gallbladder]
Rokitansky-
Aschoff
sinuses
(
R-As
)
are
epithelial
invaginations
that
extend
down
the
gallbladder
wall
through
the
smooth
muscle
gaps
and
by
this
pathway
they
reach
the
subserosal
connective
tissue
.
We
report
here
5
cases
of
mucin-containing
R-As
that
ruptured
,
and
as
a
result
,
extracellular
mucin
escaped
into
the
adjacent
stroma
.
They
were
compared
with
10
mucinous
carcinomas
of
the
gallbladder
.
Three
cases
of
mucin-containing
R-As
accompanied
by
abundant
extracellular
mucin
deposits
with
epithelial
strips
,
glands
and
papillary
structures
were
misinterpreted
as
mucinous
carcinomas
.
Because
of
this
,
the
patients
were
subjected
to
a
second
unnecessary
radical
surgical
procedure
.
In
the
remaining
2
cases
,
the
extracellular
mucin
associated
with
R-As
was
acellular
and
regarded
as
focal
.
Three
patients
were
men
and
2
women
whose
ages
ranged
from
2
to
71
years
(
average
age
52
y
)
.
The
youngest
patient
was
a
2
-
year
-old
boy
in
whom
the
mucin-containing
R-As
were
discovered
incidentally
by
magnetic
resonance
imaging
.
He
was
later
diagnosed
with
metachromatic
leukodystrophy
.
The
remaining
4
patients
complained
of
right
upper
quadrant
pain
and
had
a
thickened
gallbladder
wall
identified
by
computed
tomography
and
magnetic
resonance
imaging
.
There
were
gallstones
in
3
patients
.
The
R-As
located
in
the
lamina
propria
contained
mucin
but
were
not
cystically
dilated
whereas
those
located
in
the
subserosa
were
mucin-filled
and
often
cystically
dilated
.
Detached
fragments
of
biliary
epithelium
,
small
glands
,
and
papillary
structures
lacking
cytologic
atypia
and
mitotic
figures
were
identified
in
the
abundant
mucin
deposits
located
in
the
subserosa
of
3
cases
.
The
overlying
surface
gallbladder
epithelium
exhibited
papillary
hyperplasia
with
focal
intestinal
metaplasia
in
2
patients
,
one
of
which
had
metachromatic
leukodystrophy
.
The
lack
of
reactivity
for
carcinoembryonic
antigen
and
p
53
and
the
low
proliferative
activity
as
measured
by
MIB-
1
labeling
index
provided
additional
support
to
the
benign
nature
of
the
lesion
.
Clues
to
separate
mucin-containing
R-As
from
mucinous
carcinoma
are
provided
.
All
5
patients
with
mucin-containing
R-As
are
disease
free
8
months
to
7
years
after
surgery
(
median
follow-up
of
39
mo
)
.
Diseases
Validation
Diseases presenting
"metachromatic leukodystrophy"
symptom
carcinoma of the gallbladder
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