14800-DvRappard

155 Gallbladder and the risk of polyps and carcinoma in metachromatic leukodystrophy 9 Figure 2. Pathology of the gallbladder in MLD . Gross inspection in (A-C) showing thickening of the gallbladder wall (A, MLD-37) and medium-sized (B, MLD 60) to large polyps (C, MLD- 58). A whole mount preparation (D, MLD-37) demonstrates that thickening of the wall corresponds to prominent Rokitansky-Aschoff sinuses and muscle wall hyperplasia. (E-F) show the presence of small finger-shaped (E, MLD-60) or large polyps (F, MLD-58) protruding into the gallbladder lumen. In (G) H&E stain of patient MLD-37 shows normal mucosal epithelium. H&E stain in (H, MLD-60) depicting hyperplasia of the epithelium lining a polyp. H&E stain in (I, MLD-60) shows abundance of goblet cells in the epithelium, indicating intestinal metaplasia. The mucin contained in goblet cells is intensely PAS-positive in (J, MLD-60). H&E stain in (K) showing numerous foamy macrophages in the stroma of a polyp (MLD-58). In (L-M) the foamy macrophages are PAS-positive (L) and metachromatic (red) with the Toluidine blue stain (M), indicating that they contain sulfatides (MLD-58). In (N, MLD-58) p53 stain shows pathologic nuclear expression in the epithelium lining a polyp. In MLD-46, p53 stain shows pathologic nuclear expression (O, left), in comparison to normal absent expression in the epithelium of the wall (O, right). In (P, MLD-49) a proliferation of cytonuclear atypical epithelial cells in the gallbladder wall is shown.