Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases

Abstract

INTRODUCTION Cholecystectomy for benign gallbladder diseases can lead to previously undiagnosed gallbladder cancer during histopathological evaluation. Despite some controversy over its usefulness, histopathological evaluation of all gallbladder specimens is common in most hospitals. We evaluated the results of routine pathology of the gallbladder after cholecystectomy for benign gallbladder diseases with regard to unexpected primary gallbladder cancer (UPGC). METHODS Patients undergoing cholecystectomy because of benign gallbladder diseases between 2009 and 2013 were enrolled in this study. All gallbladder specimens were sent to the pathology department, and histopathological reports were examined in detail. The impact of demographic features on pathological diagnoses and prevalence of UPGC assessed. Data on additional interventions and postoperative survival for patients with UPGC were collected. RESULTS We enrolled 1,747 patients (mean age, 48.7±13.6 years). Chronic cholecystitis was the most common diagnosis (96.3%) and was associated significantly with being female (p=0.001). Four patients had UPGC (0.23%); one was stage T3 at the time of surgery, and the remaining three cases were stage T2. CONCLUSIONS Routine histopathological examination of the gallbladder is valuable for identification of cancer that requires further postoperative management.

Risk Management of Incidental Gallbladder Cancer in Cholecystectomy Materials

“…Gallbladder cancer is encountered 2-3 times more frequently in males than females, peaking in the seventh decade (6). Our primary carcinoma case was a 62-year-old woman.…”

“…However, jaundice, hepatomegaly and abdominal mass may be suggestive of gallbladder cancer (5). Gallstones are found in 54-97% of cases with gallbladder cancer (6). Gallbladder cancer is more common in cases with gallstones than in without.…”

“…Since 1861, several studies have been reported on the association between chronic inflammation due to gallstones and gallbladder cancer (6). Recurrent or chronic inflammatory damages cause deoxyribonucleic acid (DNA) damage, and the release of cytokines and growth factors by triggering repetitive tissue proliferation interventions during repair, resulting in a predisposition to oncogenic transformation of the cells.…”

“…In terms of cost, time and personnel savings, it is debated that whether or not all cholecystectomy materials should be sent for pathologic examination. However, when cancer is suspected on preoperative scanning or perioperative examination, histopathologic examination could be valuable (6). It is said that almost all incidental gallbladder carcinomas provide evidence in the examination performed by opening and sectioning in the operating room, because simple cholecystectomy is considered sufficient for initial stage (in situ and T1a) tumors (10).…”

“…Some studies have noted that pathologic evaluation may not be necessary if there is a correlation between imaging methods and intraoperative findings (macroscopic visual examination and mucosal examination in favor of any benign diagnosis by a surgeon). However, there is a need for further prospective and controlled studies to answer this important question (6). In fact, 15 -40% of gallbladder carcinomas can not be detected during surgery (3).…”