Odysseys of George

From the A Bitter Bladder

Gallbladder Polyp

So what is it?
Gallbladder polyps are outgrowths of the gallbladder mucosal wall. They are usually found incidentally on ultrasonography or after cholecystectomy

Issues?

Their significance relates largely to their ability to become cancerous. The majority of these are not cancerous but are hyperplastic or represent lipid deposits (cholesterolosis).
Ultrasound characteristics alone are insufficient to exclude the possibility of gallbladder carcer or pre-cancerous adenomas.
By presentation, benign lesions though usually asymptomatic, can occasionally lead to symptoms similar to those caused by gallbladder stones.

Epidemiology
Gallbladders assessed by ultrasound, less than 5% are of gallbladder polyp.
In one report, no association was observed between the presence of polyps and the patient’s age, sex, weight, number of pregnancies, use of exogenous female hormones, or any other risk factors that are generally believed to be associated with gallstones.

Types

Gallbladder polyps can be divided into whether they are cancerous type or otherwise. The cancerous type includes gallbladder cancer which is the fifth most common malignancy of the gastrointestinal tract and most common malignancy of the biliary tract.

The non-cancerous or the benign ones can be divided into

1. Cholesterol polyps ( Cholesterolosis or Strawberry Gallbladder )
- most common
- single or multiple
- usually less than 10mm size
- attached to the gallbladder wall by a delicate narrow pedicle
- The planar variety of cholesterolosis is diffuse, creating a carpet of fine yellow papules
over the mucosa surface, as seen in the picture.

- no potential to become cancerous

2. Adenomas
- most common
- may also be associated with gallstones or cholecystitis
- pre-cancerous nature of adenomas remains controversial. Many authors believe that most gallbladder cancers arise in situ from flat, dysplastic epithelium, while others propose a polyp-to-cancer sequence in which some adenomas progress to adenocarcinomas.

3. Inflammatory polyps
- rare
- inflammatory process
- commonly associated with chronic cholecystitis

4. Hyperplastic polyps
- relatively common
- found in patients without gallstones, cholecystitis,or other inflammatory processes.

5. Lymphoid polyps
- association with chronic cholecystitis
- measuring less than 5 mm.
- found in all layers of the gallbladder wall

6. Fibrous polyps
7. Granulation tissue polyps

Clinical Presentations

- usually asymptomatic
- pain similar to gallstone disease
- dyspeptic symptoms

Difficulty

Differentiation between benign polypoid lesion and cancerous lesion can be very difficult, even with highresolution imaging techniques.
In two studies, the polyp size on ultrasound image was a useful discriminator. Both groups found that malignant lesions tended to be single and larger than 10 mm, and occurred in older patients.

How to manage?

If symptomatic — remove as of cholecystectomy

If asymptomatic
— polyp larger than 10mm — remove as of cholecystectomy

— polyp smaller < 10mm
-- patient >50 years old with or without gallstones - cholecystectomy

— otherwise — suggested follow-up 6monthly with ultrasound

This entry was posted on Saturday, December 30th, 2006 at 2:21 pm and is filed under Medical. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.