14800-DvRappard

151 Gallbladder and the risk of polyps and carcinoma in metachromatic leukodystrophy 9 Gross examination revealed presence of polyps in 7 patients (MLD-2, MLD-30, MLD-38, MLD-46, MLD-58, MLD-60, and MLD-63; figure 2), including 2 in whom these were not identified at ultrasound. Microscopically, the polypswere linedby normal to hyperplastic epithelium (figure 2 H). Multiple foci of intestinal metaplasia with clustered goblet cells were present in the polyps as well as in the mucosa of the wall (figure 2 I). In places, mild architectural and cytologic changes of the polyp epithelium were also seen, including nuclear hyperchromasia and stratification. Stain for p53 was focally positive in 2 patients (figure 2 N and O). There were no cholesterol polyps. In 3 HSCT-treated and 5 untreated patients (including 2, MLD-58 and MLD-63, in whom cholecystectomy was performed prior to HSCT), premalignant changes (intestinal or gastric metaplasia and hyperplasia) were found. Figure 1. Gallbladder ultrasound findings in MLD . In (A), an 8mm polyp in the gallbladder of a transplanted patient (MLD-30) is depicted. (B) shows a 10mm polyp in the gallbladder of a patient before transplantation (MLD-58). Cholelithiasis is present in (C) in a non-transplanted patient (MLD-6). A gallbladder with multiple polyps (maximal diameter 4mm) in a non- transplanted patient (MLD-35) is shown in (D). (E) shows a gallbladder with thickened wall and sludge in a non-transplanted patient (MLD-38) with episodes of severe colic-like pain. Polyps are not discernible, but were present at histopathological examination. A small and contracted gallbladder with thickened wall and polyps in a non-transplanted patient is seen in (F) (MLD- 63).