Gallbladder polyps in children--classification and management

Abstract

Polypoid lesions of the gallbladder (PLG) are rare in childhood. The authors describe 2 additional cases. A 12 year-old-girl was found to have a 5-mm gallbladder polyp during an ultrasound examination for nonspecific abdominal pain. Investigation showed no other biliary tract abnormality. During the next 5 years, she was reviewed periodically with ultrasound scans and underwent cholecystectomy when the diameter of the polyp increased to 1 cm. Histology results showed a benign cholesterol polyp. A 12-year-old-boy was found to have an incidental gallbladder polyp, which 2 years later remained static in size for 10 months. The polyp had disappeared spontaneously. The authors suggest that PLGs in children may be either primary or secondary. Only 11 primary PLGs have been reported, and their histology is variable (adenoma, gastric heterotopia, and epithelial hyperplasia). Secondary PLGs may be found in association with metachromatic leukodystrophy, Peutz-Jeghers syndrome, or pancreato-biliary malunion. The pathologic spectrum of PLGs in children appears to be different from that in adults. For primary PLGs, cholecystectomy is advisable if there are biliary symptoms or if the polyp is > or =1 cm in size. Asymptomatic cases should be maintained under ultrasound surveillance.