Gallbladder polyps: Diagnosis and treatment
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233 Hellenic Journal of Surgery 2010; 82: 2
Gallbladder Polyps: Diagnosis and Treatment Review Article N. Baltayiannis, Th. Gavressea, S. Rizos Received 08/02/2010 Accepted 12/03/2010
Abstract Gallbladder polyps are relatively common in adults and affect approximately 5% of the population. Polypoid lesions of the gallbladder are asymptomatic and are detected during abdominal ultrasonography performed for unrelated conditions. Although the majority of gallbladder polyps are benign, malignant transformation is a concern. The differentiation of benign from malignant lesions can be challenging. Several features, including polyp size, number, rapid growth, sessile lesion, patient age and gallbladder wall thickening are important discriminating features between benign and malignant polyps and may increase the risk of gallbladder cancer. Histopathologic analysis of polypoid lesions of the gallbladder continues to be the gold standard to identify malignancy. Ultrasound has been used extensively in the pre-operative management of these lesions, but modern ultrasound techniques are unable to differentiate between benign and malignant polyp of the gallbladder with any certainty. We recommend surgical treatment of polypoid lesions of the gallbladder in symptomatic patients, as well as in asymptomatic individuals over 50 years of age, or those whose polyps are solitary, sessile, greater than 6 mm in diameter, that demonstrate rapid growth, vascularity and invasion or are associated with gallstones.
Keywords
Gallbladder polyps, Polypoid lesions of the gallbladder, Benign gallbladder polyps, Malignant gallbladder polyps, Gallbladder cancer
Introduction Gallbladder polyps are growths or lesions resembling growths (polypoid lesions) that protrude from the mucosal surface of the gallbladder [1]. They
-Metaxa Cancer Hospital, Piraeus ,Greece. -Tzaneio General Hospital of Piraeus, Greece. e-mail: [email protected]
are incidentally identified during ultrasonography examination in 5% of the patients with abdominal pain and 4-7% of healthy people [2,3]. Up to the 1990s, the discovery of a gallbladder polyp caused great perplexity to doctors of different specialities. Physicians ignored this entity, radiologists had the tendency to underrate it and pathologists, with their histological reports, added to the confusion and uncertainties surrounding the correct management [4]. Over the last 20 years, the development and improvement of diagnostic imaging techniques such as computerized tomography (CT), magnetic reasonance imaging (MRI) and ultrasonography (US) and their extensive use have led to a significant increase in the diagnosis of gallbladder polypoid lesions. As a result, increasingly more surgeons are confronted with patients that present with a gallbladder polyp diagnosed by an ultrasound scan, seeking the best treatment [5]. Polypoid lesions of the gallbladder may be benign or malignant. In 1970, Christensen and Ishak classified gallbladder’s polyps as benign tumours such as adenoma, fibroma, hemangioma, leomyoma, lipoma, in
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