Indian Journal of Pathology and Oncology 2020;7(2):338–342 Content available at: iponlinejournal.com Indian Journal of Pathology and Oncology Journal homepage: www.innovativepublication.com Case Report Pyloric gland adenoma of gallbladder with squamoid morules in pediatric age Ashutosh Gupta 1 , Amit Choraria 1, *, Shantanu Tiwari 1 , Vishakha Tikeykar 2 , Vivek Chaudhary 3 1 Dept. of Surgical Oncology, Regional Cancer Center, Pt. JNM Medical College, Raipur, Chhattisgarh, India 2 Dept. of Pathology, SRL Diagnostics, Mumbai, Maharashtra, India 3 Dept. of Radiotherapy, Regional Cancer Center, Pt JNM Medical College, Raipur, Chhattisgarh, India ARTICLE INFO Article history: Received 11-07-2019 Accepted 14-12-2019 Available online 25-05-2020 Keywords: Gall bladder polyp Pyloric gland type Adenoma ABSTRACT Case Report: 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 nd post operative day without any complications. Histopathology and Immunohistochemistry revealed pyloric gland adenoma with squamoid morules. Discussion: 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. Conclusion: 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. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/) 1. Case Report A 7 year old girl presented at our center with complaints of pain in upper abdomen on and off since 2 months. She was being treated with pain killers, but with no relief. An ultrasonography of the abdomen was performed which revealed a 2 x 1.3 x 0.83 cm echogenic polypoidal mass which had a vascular pedicle [Figure 1]. A low impedance flow was observed in the mass. An MRCP was performed which revealed an endophytic polypoidal T2 hypotense lesion measuring approximately 1.8 x 1.3 x 1.2 cm in * Corresponding author. E-mail address: dr.amitchoraria@gmail.com (A. Choraria). size. It was found to be arising from the anterior fundal wall showing mild homogenous post contrast enhancement [Figure 2]. The pericholecystic fat planes were maintained. There was no evidence of biliary obstruction. A likely diagnosis of gall bladder adenoma was made. A standard four port Laparoscopic Cholecystectomy was performed and the specimen was retrieved in plastic bag through the umbilical port. It was sent for histopathological examination and immunohistochemistry. No peritoneal drain was used. The patient was discharged on 2 nd post operative day. No post operative complications were observed. https://doi.org/10.18231/j.ijpo.2020.067 2394-6784/© 2020 Innovative Publication, All rights reserved. 338