Pyloric gland adenoma of gallbladder with squamoid morules in pediatric age

Abstract

7 year old symptomatic girl was diagnosed with gall bladder polyp on ultrasonography and MRCP (magnetic resonance cholangiopancreatography). Laparoscopic cholecystectomy was performed and patient was discharged on 2 post operative day without any complications. Histopathology and Immunohistochemistry revealed pyloric gland adenoma with squamoid morules.Gall bladder polyps are seen in 5% of the adult population around the world but rarely seen in children. Polyps have the potential to convert into malignancy and hence early diagnosis and differentiation is necessary.Most of the patients with gall bladder adenomas are adult females. Majority of the adenomas (91%) are single. Squamoid morules was found in 28% and columnar oxyphil cells in 2% of these adenomas. High-grade dysplasia/carcinoma in situ was seen in 27% of them and low-grade dysplasia in 15%. However, only 1% invasive adenocarcinomas were diagnosed in pyloric gland adenomas, both of which were intestinal type. For symptomatic patients who have pain and dyspepsia, cholecystectomy is the recommended treatment. For asymptomatic or incidentally detected patients, the indications for cholecystectomy should be age more than 50 years, solitary polyp greater than 10mm in largest dimension, accompanying gall stones and increase in size on serial sonographies.As per our knowledge the case we report is the first case of gallbladder pyloric adenoma with squamoid morules in pediatric age group. Treatment with simple cholecystectomy is recommended in view of literature suggesting pre malignant lesion.