Routine histopathology of gallbladder after elective cholecystectomy for gallstones: waste of resources or a justified act?

Abstract

BackgroundSelective approach for sending cholecystectomy specimens for histopathology results in missing discrete pathologies such as premalignant benign lesions such as porcelain gallbladder, carcinoma-in-situ, and early carcinomas. To avoid such blunders therefore, every cholecystectomy specimen should be routinely examined histologically. Unfortunately, the practice of discarding gallbladder specimen is standard in most tertiary care hospitals of Pakistan including the primary investigators’ own institution. This study was conducted to assess the feasibility or otherwise of performing histopathology in every specimen of gallbladder.MethodsThis cohort study included 220 patients with gallstones for cholecystectomy. All cases with known secondaries from gallbladder, local invasion from other viscera, traumatic rupture of gallbladder, gross malignancy of gallbladder found during surgery was excluded from the study. Laparoscopic cholecystectomy was performed in majority of cases except in those cases where anatomical distortion and dense adhesions prevented laparoscopy. All gallbladder specimens were sent for histopathology, irrespective of their gross appearance.ResultsOver a period of two years, 220 patients with symptomatic gallstones were admitted for cholecystectomy. Most of the patients were females (88%). Ninety two per cent patients presented with upper abdominal pain of varying duration. All specimens were sent for histopathology. Two hundred and three of the specimens showed evidence chronic cholecystitis, 7 acute cholecystitis with mucocele, 3 acute cholecystitis with empyema and one chronic cholecystitis associated with poly. Six gallbladders (2.8%) showed adenocarcinoma of varying differentiation along with cholelithiasis.ConclusionThe histopathological spectrum of gallbladder is extremely variable. Incidental diagnosis of carcinoma gall bladder is not rare; if the protocol of routine histopathology of all gallbladder specimens is not followed, subclinical malignancies would fail to be identified with disastrous results. We strongly recommend routine histopathology of all cholecystectomy specimens.

Incidental Detection of Carcinoma Gall Bladder in Laparoscopic Cholecystectomy Specimens: A Thirteen Year Study of 23 Cases and Literature Review

“…None of the pts in T1 stage carcinoma had perineural invasion. Similar results were obtained in studies by Siddiqui and Ghnnam et al [10,14].…”

Gall bladder specimen following cholecystectomy: a resource

“…Only one study by Siddiqui et al matches the incidence as found by this study. 27 Some studies have however depicted an incidence of 0.3-1.5% which is lower than the rate of this study. 30,31 Conversely, other studies have depicted a higher prevalence rate such as 6.9 -12.3 %.…”

“…25,26 Majority of the patients were found to have presented with pain in the abdomen which is consistent with the findings of Siddiqui et al and slightly different from the reports of Fletcher et al who reported that all patients presented with pain. 27,28 With respect to the histopathological findings, the most common finding that was seen was acute cholecystitis (51%) followed by chronic cholecystitis(46%) with 3% depicting adenocarcinoma. Specimens reportedly had inflammation presenting with mucosal denudation, ulceration with some reports of metaplasia to dysplasia.…”

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

“…3 However, the necessity of histological analyses for all gallbladder specimens has been questioned. 1,4 Simple cholecystectomy can be regarded as adequate treatment of all benign and early malignant T1 gallbladder lesions.…”