Clinicopathologic Features of Polypoid Lesions of the Gallbladder and Risk Factors of Gallbladder Cancer

Abstract

It is difficult to differentiate benign and malignancy in polypoid lesions of the gallbladder (PLG) by solely depending on imaging studies. Therefore clinicopathologic features of benign and malignant polyps are compared in an attempt to identify the risk factors of malignant polypoid lesions. The medical records of 291 patients who were confirmed to have PLG through cholecystectomy were reviewed and analyzed for age, sex, symptom, associated gallstone, morphology of PLG, size of PLG, number of PLG, and preoperative tumor markers. Benign PLG was found in 256 patients (88.0%) and malignant PLG in 35 patients (12.0%). Compared with benign group, the malignant group were older (61.1 yr vs. 47.1 yr, P<0.001), more often accompanied with symptoms (62.9% vs. 28.9%, P<0.001). Malignant PLG tended to be sessile (60.0% vs. 10.5%, P<0.001), larger (28.0 mm vs. 8.6 mm, P<0.001) and single lesion (65.7% vs. 44.1%, P<0.016). Age over 60 yr (P=0.021, odds ratio [OR], 8.16), sessile morphology (P<0.001, OR, 7.70), and size over 10 mm (P=0.009, OR, 8.87) were identified as risk factors for malignant PLG. Careful decision making on therapeutic plans should be made with consideration of malignancy for patients over 60 yr, with sessile morphology of PLG, and with PLG size of over 10 mm.

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

“…Several reports showed that polypoid lesion is highly likely to be cancerous if it is sessile and/or solitary, its diameter is equal to or greater than 10 mm, patient's age is equal to or greater than 60 years old, and/or it grows rapidly [28][29][30][31][32]. According to these results, when polypoid lesion of the gallbladder is sessile, has a diameter equal to or greater than 10 mm and/or grows rapidly, it is highly likely to be cancerous and should be resected by cholecystectomy [28][29][30][31][32][33][34][35][36].…”

Laparoscopic Management of Gall Bladder Polyp

“…For such reason, polypoid lesions of the gallbladder are often detected incidentally. [3,9] However, there are some patients with gallbladder polyps which may suffer nausea, vomiting, and occasional pain in the right hypochondrium, due to intermittent obstructions caused by small fragments of cholesterol that become detached from the gallbladder mucosa. There are descriptions of polyps that protrude greatly obstructing the cystic canal or the primary biliary ducts, causing acute cholecystitis or obstructive jaundice, but these are very rare complications.…”

“…[1,3,8,34,35] Polyp size has long been noted to be an important factor. Gallbladder polyps larger than 1.5 cm, especially in solitary sessile hypoechogenic polyps, are associated with a risk of malignancy.…”

“…Therefore, a speculation can be made that symptom may be associated with the size of the polyp rather than the association of gallstone. [3] Imaging of gallbladder polyps…”

Fate of Dyspeptic or Colonic Symptoms After Laparoscopic Cholecystectomy

“…However, a minority of patients report abdominal symptoms that are similar to those induced by small gallstones that are rarely detached from the mucosa. 6 When cholecystectomy is recommended, many patients wondered about the relief of their symptoms and about any occurrence of new symptoms after removing the gallbladder. However, many studies have reported that the changes in abdominal symptoms after laparoscopic cholecystectomy (LC) may differ according to the selection of patients and their preoperative conditions.…”