Routine examination of gallbladder specimens after cholecystectomy: a single-centre analysis of the incidence, clinical and histopathological aspects of incidental gallbladder carcinoma

Abstract

Background Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy—this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate and this study evaluates the role of regular specimens’ examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC. Methods Patients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student’s t-test and ANOVA. Results Some 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in six cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease—73.7 $$\pm$$ ± 5.38 years vs 55.8 $$\pm$$ ± 0.79 years (p < 0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage—one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression—median survival was 7 months (range 2–14). Conclusions In this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.

Incidental Gallbladder Neoplasms: A Growing Global Burden

“…The pancreaticobiliary type of adenocarcinoma is the most common subtype encountered on HPE representing almost 90-95% of all the gallbladder malignancies followed by squamous or adenosquamous carcinomas [ 1 - 2 , 4 , 7 - 8 , 10 , 12 , 14 - 15 ]. The majority of the malignant cases in the present study were also adenocarcinomas, which was in accordance with the above-mentioned studies.…”

Incidental Gallbladder Carcinoma in North Indian Population: Importance of Routine Histopathological Examination of All Benign Gallbladder Specimens

“…The association of wall thickness with pathological stages IGBC is defined as carcinoma of gallbladder diagnosed first time on histopathological examination after cholecystectomy done for benign gallbladder disease without clinico-radiological and intraoperative suspicion of malignancy [4,5]. The incidence of IGBC is reported to be 0.2% to 3.3% of all cholecystectomies specimen of benign gallbladder disease [5,6,[8][9][10][11]. This range is due to the geographical and racial heterogenous distribution of gallbladder malignancies worldwide [3].…”

“…Nevertheless, there are studies that discourage the routine histopathological examination of all gallbladder specimens stating that it is unnecessary to put a burden of cost and workload on pathologists and they suggested a selective approach of histopathological examination of cholecystectomy specimen [6,8,15].…”

“…Incidental gallbladder carcinoma (IGBC) is defined as cancer discovered at the time of histopathological examination of the specimen after cholecystectomy done for benign gallbladder disease without clinicoradiological and intraoperative suspicion of malignancy [1,5]. Studies have shown that the incidence of IGBC ranges from 0.2% to 3.3% in all cholecystectomies specimen of benign disease [6]. Gallstone disease is the major risk factor for gallbladder cancer along with other less commonly observed risk factors like calcification of gallbladder wall, adenomatous polyp, obesity, estrogen, choledochal cyst, and chemical carcinogens [1,2,4].…”

Guest edited collection: current friends and foes in gastrointestinal cancer

“…Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy: this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate and the study from Dr. Manzelli’s team, evaluates the role of regular specimens’ examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC [ 26 ]. They examined the pathology reports of almost 6000 gallbladder specimens, finding the incidence of IGC as low as 0.1%.…”