Gallbladder polyps: Correlation of size and clinicopathologic characteristics based on updated definitions

Taşkin, Orhun Çığ; Baştürk, Olca; Reid, Michelle D.; Dursun, Nevra; Bağcı, Pelin; Saka, Burcu; Balcı, Serdar; Memiş, Bahar; Bellolio, Enrique; Araya, J. C.; Roa, Juan Carlos; Tapia, O.; Losada, Héctor; Sarmiento, Juan M.; Jang, Kee Taek; Jang, Jin Young; Pehlivanoğlu, Burçin; Erkan, Mert; Adsay, Volkan

doi:10.1371/journal.pone.0237979

Cited by 27 publications

(26 citation statements)

References 28 publications

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“…More importantly, in the two largest series on the topic the mean size of pyloric gland adenomas reported were 0.6 and 0.8 cm 64,65 . It has been shown amply since then that pseudo‐pyloric gland metaplasia is very common in gallbladder injury, 35 and often forms small collections which do not fulfil the criteria of a neoplastic lesion as defined recently 31,56 . True ‘adenomas’ are distinguished from polypoid pseudo‐pyloric gland metaplasia, in addition to their larger (>1 cm) size, by their sharply demarcated nature and uniform back‐to‐back clonal‐appearing glands without any intervening stroma (Figure 4).…”

Section: Precursor Lesionsmentioning

confidence: 98%

Dysplasia and carcinoma of the gallbladder: pathological evaluation, sampling, differential diagnosis and clinical implications

2021

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Pathological evaluation of gallbladder neoplasia remains a challenge. A significant proportion of cases presents as clinically and grossly inapparent lesions, and grossing protocols are not well established. Among epithelial alterations, pseudo‐pyloric gland metaplasia is ubiquitous and of no apparent consequence, whereas goblet cell metaplasia and a foveolar change in surface cells require closer attention. Low‐grade dysplasia is difficult to objectively define and appears to be clinically inconsequential by itself; however, extra sampling is required to exclude the possibility of accompanying more significant lesions. For high‐grade dysplasia (‘high‐grade BilIN’, also known as ‘carcinoma in situ’), a complete sampling is necessary to rule out invasion. Designating in‐situ or minimally invasive carcinomas limited to muscularis or above as early gallbladder carcinoma (EGBC) helps to alleviate the major geographical differences (West/East) in the criteria for ‘invasiveness’ to assign a case to pTis or pT1. Total sampling is crucial in proper diagnosis of such cases. A subset of invasive GBCs (5–10%) arise from the intracholecystic neoplasm (ICN, ‘adenoma‐carcinoma sequence’) category. Approximately two‐thirds of ICNs have invasive carcinoma. However, this propensity differs by subtype. True ‘pyloric gland adenomas’ (> 1 cm) are uncommon and scarcely associated with invasive carcinoma. A distinct subtype of ICN composed of tubular, non‐mucinous MUC6+ glands [intracholecystic tubular non‐mucinous neoplasm (ICTN)] forms a localised pedunculated polyp. Although it is morphologically complex and high‐grade, it appears to be invasion‐resistant. Some of the invasive carcinoma types in the gallbladder have been better characterised recently with adenosquamous, neuroendocrine, poorly cohesive and mucinous carcinomas often being more advanced and aggressive.

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Section: Precursor Lesionsmentioning

confidence: 98%

Dysplasia and carcinoma of the gallbladder: pathological evaluation, sampling, differential diagnosis and clinical implications

2021

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“…Since GPLs in the size range of 10–12 mm were unlikely to be malignant, surgical indication for GPLs larger than 13 mm can prevent 50% of unnecessary cholecystectomies without the risk of missing malignant GPLs. According to a clinicopathological study [ 22 ], 90% of polyps 10 mm or larger than 10 mm in size are neoplastic. However, since 30% of neoplastic polyps are smaller than 10 mm, even small polyps need to be carefully monitored, especially in elderly patients.…”

Section: Differentiation Of Gb Polypoid Lesions (Gpls)mentioning

confidence: 99%

How Can We Manage Gallbladder Lesions by Transabdominal Ultrasound?

Okaniwa

2021

Diagnostics

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The most important role of ultrasound (US) in the management of gallbladder (GB) lesions is to detect lesions earlier and differentiate them from GB carcinoma (GBC). To avoid overlooking lesions, postural changes and high-frequency transducers with magnified images should be employed. GB lesions are divided into polypoid lesions (GPLs) and wall thickening (GWT). For GPLs, classification into pedunculated and sessile types should be done first. This classification is useful not only for the differential diagnosis but also for the depth diagnosis, as pedunculated carcinomas are confined to the mucosa. Both rapid GB wall blood flow (GWBF) and the irregularity of color signal patterns on Doppler imaging, and heterogeneous enhancement in the venous phase on contrast-enhanced ultrasound (CEUS) suggest GBC. Since GWT occurs in various conditions, subdividing into diffuse and focal forms is important. Unlike diffuse GWT, focal GWT is specific for GB and has a higher incidence of GBC. The discontinuity and irregularity of the innermost hyperechoic layer and irregular or disrupted GB wall layer structure suggest GBC. Rapid GWBF is also useful for the diagnosis of wall-thickened type GBC and pancreaticobiliary maljunction. Detailed B-mode evaluation using high-frequency transducers, combined with Doppler imaging and CEUS, enables a more accurate diagnosis.

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“…In addition, the changes inherent in cholesterolosis include signs of many local pathological processes. Thus, in the literature there are no clear differential differences between "cholesterol polyp" and sclerosed and deformed villi (folds) [26].…”

Section: Introductionmentioning

confidence: 99%

Gallbladder cholesterolosis in patients with metabolic syndrome and chronic pancreatitis

et al. 2021

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Cholesterolosis, as a pathological condition caused by metabolic disorders, is potentially associated with metabolic syndrome and chronic pancreatitis. The aim of the study was to assess the prevalence and morphological features of gallbladder cholesterolosis in the contingent of patients with metabolic syndrome and chronic pancreatitis. 82 patients who underwent cholecystectomy for chronic calculous cholecystitis were included in our study. The experimental group consisted of 37 patients with metabolic syndrome and chronic pancreatitis. The comparison group included 45 patients without clinically confirmed metabolic syndrome and chronic pancreatitis. In accordance with the purpose and objectives, morphological examination of the gallbladder wall was performed. Data to be analyzed were processed using the statistical software package SPSS 20.0 for Windows. The gender and age structure of the studied contingent did not differ from that described in the scientific literature. The morphological picture of cholesterolosis did not differ in the study groups. In a mucous membrane considerable polymorphism of folds (villi) was noted. There were signs of desquamation and regeneration in the epithelium. There was a violation of the structure Rokitansky-Aschoff sinuses. In some crypts microconcretions were defined. Atrophy and sclerosis of the stroma of the villi were detected in the mucous membrane. Significant expansion of the lumen of the veins in the own plate of the mucous membrane and the perimuscular layer of the gallbladder wall was noteworthy. Signs of stasis were found in the lumen of blood vessels. The lumen of the arteries was narrowed in places due to swelling and accumulation of yellow-brown pigment. Signs of spasm and significant sclerosis of the wall were identified. Dystrophic changes in the endothelium contribute not only to the development of uneven plethora of stagnant nature with significant edema, but also hemorrhage. Significant swelling of all layers was characteristic, causing their disintegration. Significant dilation of lymphatic vessels causes a significant thickening of the gallbladder wall. In some places, there is uneven hypertrophy of the muscle layer. There was an excessive increase in the tortuosity ducts of Luschka. According to the study, patients with metabolic syndrome and chronic pancreatitis, operated on for chronic calculous cholecystitis, along with maintaining the gender and age structure of the contingent, there is a significantly higher incidence of gallbladder cholesterolosis.

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Gallbladder polyps: Correlation of size and clinicopathologic characteristics based on updated definitions

Cited by 27 publications

References 28 publications

Dysplasia and carcinoma of the gallbladder: pathological evaluation, sampling, differential diagnosis and clinical implications

Dysplasia and carcinoma of the gallbladder: pathological evaluation, sampling, differential diagnosis and clinical implications

How Can We Manage Gallbladder Lesions by Transabdominal Ultrasound?

Gallbladder cholesterolosis in patients with metabolic syndrome and chronic pancreatitis

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