Clinicopathological Study of Gallbladder Lesions

Abstract

Background: Gallbladder is one of the most frequently surgically resected organs which stores and concentrates the bile and is involved by both non neoplastic as well as neoplastic diseases. Chronic calculous cholecystitis is the most common benign lesion of gallbladder and pain abdomen is the commonest clinical presentation. Both non neoplastic and neoplastic lesions have similar clinical presentation and overlapping radiological findings. Methods:Total 550 cholecystectomy specimens were received in pathology department. Grossly, formalin fixed specimens were examined carefully and section were given from neck, fundus and body of gallbladder. Whenever it was necessary, additional sections were given. After processing, the H&E stained sections were studied thoroughly. All the clinical details were taken from case papers. Result:The commonly seen non neoplastic lesions were chronic calculous cholecystitis (405 cases), chronic cholecystitis (85 cases), Acute on chronic cholecystitis with or without stones (18 and 3 cases), acute necrotizing cholecystitis (2 cases), eosinophilic cholecystitis (3 cases), follicular cholecystitis (3cases), lymphoplasmacytic cholecystitis (1case), xathogranulomatous cholecystitis (9 cases), cholesterosis (4 cases), mucocele of gall bladder (2 cases), adenomyomatosis (3 cases) and gallbladder cholesterol polyp with cholecystitis (2 cases). Among neoplastic lesions 1 case was adenoma with severe dysplasia and 9 cases were adenocarcinoma. Conclusion:Chronic calculous cholecystitis was the most common lesion and out of 9 cases of carcinoma, 7 cases were diagnosed incidentally. Therefore, histopathological evaluation plays a critical role in identifying incidental gallbladder carcinoma for proper management of patients.

Can gallbladder wall thickness by gross examination predicts its carcinoma before histopathological study?

“…Comparison of incidence of gallbladder carcinoma in the present study with other studies: Incidence of carcinoma gallbladder found in the present study was 1.89% (6 cases), which correlated very well to the incidence found in the study conducted by Murmu S et al [10] (2 cases, 1.88%), Kumar H et al [11] (North Indian data-8 cases, 2%, South Indian data-5 cases, 1.25%) and the study by Kumari G et al [12] (7 cases, 1.27%). A lower incidence was observed in studies done by Beena D et al [13] (1 case, 0.5%), Mondal B et al [14] (5 cases, 0.6%), Sharma I et al [15] (3 cases, 0.86%) and H Mohan et al [16] (12 cases, 1.09%).…”

“…These results were comparable to the study done by Levy DA et al [17] in which 68% cases were grey white irregular mass lesions and 60% of the tumour originate in fundus of the gallbladder. Also comparable to the study done by Kumari G et al [12] where 90% of the cases were grey white irregular mass lesions.…”

“…According to the present study, statistical analysis revealed significant association of thickness of gallbladder wall grossly and carcinoma gallbladder (at p< 0.05). 83.4% of the gallbladder carcinomas were associated with thickened gallbladder wall (>3mm) [12]. Hence the association of thickened gallbladder wall with carcinoma gallbladder could be considered.…”

“…This result holds good for correlation with the study done by Mittal R et al [18], where 70% (9 cases) of gallbladder carcinomas had thickened wall macroscopically. Also, different studies done by Kumari G et al [12], Haq N et al [19], Romero-Gonzalez RJ et al [20], Levy DA et al [17] had observed increased gallbladder thickness as one of the risk factor for gallbladder carcinoma and advised for thorough gross examination.…”

Clinicopathological study of calculous cholecystitis

“…1 Gallbladder lesions are very common in fatty, fertile, females of around forty age group. 2 In India and in western countries, the incidence of cholelithiasis is increasing due to change in lifestyle, food habits and consumption of alcohol. 2 The gallstone disease prevalence is 6-12% in India and 10-15% in Western population.…”