J Korean Surg Soc JKSS Journal of the Korean Surgical Society 1226-0053 2093-0488 The Korean Surgical Society 10.4174/jkss.2010.79.Suppl1.S58 Case Report Cholelithiasis with Mucosal Dysplasia of the Gallbladder in a 2-year-old Child Choi Kun Moo M.D. Park Ki Young M.D. 1 Eom Dae Woon M.D. 2 Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea. Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea. Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea. Corresponding author (goodnews@gnah.co.kr) 12 2010 31 12 2010 79 Suppl 1 S58 S61 22 02 2010 24 05 2010 Copyright © 2010 The Korean Surgical Society 2010

Traditionally, it has been emphasized that hemolytic disease was the primary cause of gallstones (cholelithiasis) in most young patients. In recent years, gallstones and common bile duct calculi have been increasingly diagnosed in infants and children, unrelated to hemolytic diseases. On the matter, the World Health Organization (WHO) classified intraepithelial neoplasia (dysplasia) of gall bladder as one of the precursor lesions of invasive cancer. The following article describes the case of a 2-year-old girl who had a laparoscopic cholecystectomy due to cholelithiasis and the pathologic diagnosis was chronic cholecystitis with diffuse, mild mucosal dysplasia.

 Cholelithiasis Mucosal dysplasia Albores-Saavedra J Scoazec J Wittekind C Stripa B Menke HR Soehendra N Stanley RH Lauri AA Tumors of the gallbladder and extrahepatic bile ducts World Health Organization Classification of Tumors of the Digestive System 1999 4th ed Lyon IARC 211 213 Roa I de Aretxabala X Araya JC Roa J Preneoplastic lesions in gallbladder cancer J Surg Oncol 2006 93 615 623 Lugo-Vicente HL Trends in management of gallbladder disorders in children Pediatr Surg Int 1997 12 348 352 Kumar R Nguyen K Shun A Gallstones and common bile duct calculi in infancy and childhood Aust N Z J Surg 2000 70 188 191 Robertson JF Carachi R Sweet EM Raine PA Cholelithiasis in childhood: a follow-up study J Pediatr Surg 1988 23 246 249 Gilliland TM Traverso LW Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms Surg Gynecol Obstet 1990 170 39 44 St Peter SD Keckler SJ Nair A Andrews WS Sharp RJ Snyder CL Laparoscopic cholecystectomy in the pediatric population J Laparoendosc Adv Surg Tech A 2008 18 127 130 Bailey PV Connors RH Tracy TF Jr Sotelo-Avila C Lewis JE Weber TR Changing spectrum of cholelithiasis and cholecystitis in infants and children Am J Surg 1989 158 585 588 Duarte I Llanos O Domke H Harz C Valdivieso V Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples Cancer 1993 72 1878 1884 Kozuka S Tsubone N Yasui A Hachisuka K Relation of adenoma to carcinoma in the gallbladder Cancer 1982 50 2226 2234

Abdominal ultrasound showed prominent intrahepatic duct (IHD) and common bile duct (CHD) dilatation (A) and two small stones in the far distal common bile duct (d-CBD), near the ampulla of Vater (AoV) (B).

Magnetic resonance cholangiopancreatogram (MRCP) showed markedly decompressed duct dilatation and swollen ampulla of Vater (AoV) without stones.

Three 5 mm ports were used for laparoscopic cholecystectomy. The 5 mm umbilical port was for a 0-degree forward-viewing telescope connected to the camera.

The mucosa of the gallbladder is diffusely lined by uniform pseudostratified columnar epithelial cells with papillary structure (H&E stain, ×200).