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. 2021 Feb;28(1):27-34.
doi: 10.21315/mjms2021.28.1.4. Epub 2021 Feb 24.

Incidental Gallbladder Carcinoma in Gallbladder Polyps: Challenges of Gallbladder Malignancy for an Endemic Population

Abhishek Gautam  1 , Anshuman Pandey  1 , Shakeel Masood  1 , Smita Chauhan  1 , Dinesh Choudhary  1 , Suneed Kumar  1 , Shibumon Madhawan  1 , Sneha Jha  1 , Vijay Saini  1
Affiliations

Incidental Gallbladder Carcinoma in Gallbladder Polyps: Challenges of Gallbladder Malignancy for an Endemic Population

Abhishek Gautam et al. Malays J Med Sci. 2021 Feb.

Abstract

Background: Gallbladder polyps are considered pre-malignant lesions of gallbladder carcinoma. This study aims to highlight the role of early cholecystectomy in the management of gallbladder polyps in an endemic population.

Methods: A retrospective analysis of 2,076 lap cholecystectomy procedures performed at the Department of Surgical Gastroenterology at a tertiary referral centre in Northern India was conducted and incidental malignancy in gallbladder polyps analysed. The 8th edition of the American Joint Committee on Cancer for tumour-node-metastasis (TNM) staging of gallbladder carcinoma was used.

Results: Of 54 patients with gallbladder polyps, 53 had benign histology and one had malignant cells in the lamina propria suggestive of T1a adenocarcinoma. The patient with the malignant polyp was older (57 years old) than the patients in the non-cancer group, which had a mean age of 45 (P = 0.039). The size of the malignant polyp was approximately 4 mm, significantly smaller than the average 7.9 mm size of the benign polys (P = 0.031).

Conclusion: Cholecystectomy needs to be considered early in the management of small-sized gallbladder polyps, particularly in areas endemic for gallbladder carcinoma.

Keywords: endemic area; gallbladder carcinoma; gallbladder polyp; size.

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Conflict of interest statement

Conflict of Interest None.

Figures

Figure 1
Figure 1
A. Portal venous phase CECT abdomen of a 49-year-old male who underwent laparoscopic cholecystectomy for GB polyp presenting with right hypochondrial pain. Final HPE turned out to be benign. B. Transabdominal ultrasound imaging in supine position of the same patient, as in the first figure. An intraluminal hyperechoic lesion with no acoustic shadowing with the typical appearance of ‘ball on the wall’ appearance is seen on the hepatic surface of the gallbladder. C. Intraoperative image of a gallbladder after cut open. On macroscopic examination, nearly 5 mm polyp can be seen close to the neck of the gallbladder. It is imperative to examine the whole specimen cut open carefully, not be missed any focal thickening or presence of any nodule
Figure 2
Figure 2
A. Transabdominal ultrasound of 57 years old patient with malignant polyp. Polyp is appreciated on the peritoneal side of gall bladder with no evidence of any focal thickening or stone. B. Microscopic image of tumour cells deposited in the lamina propria of the gallbladder wall. C. Well differentiated adenocarcinoma within the lamina propria. D. Muscle layer is free of the tumour cells (H&E original magnification 40×)
Figure 3
Figure 3
Classification of gallbladder polyps
See this image and copyright information in PMC

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