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Gallbladder polyps and cholesterolosis

INTRODUCTION

Gallbladder polyps are outgrowths of the gallbladder mucosal wall. They are usually found incidentally on ultrasonography or after cholecystectomy. When detected on ultrasonography, their clinical significance relates largely to their malignant potential. The majority of these lesions are not neoplastic but are hyperplastic or represent lipid deposits (cholesterolosis). Imaging studies alone are insufficiently specific to exclude the possibility of gallbladder carcinoma or premalignant adenomas. Furthermore, even benign lesions can occasionally lead to symptoms similar to those caused by gallbladder stones.

While the widespread use of ultrasonography has made the diagnosis of polypoid lesions of the gallbladder increasingly frequent, optimal strategies for evaluating these lesions have not been fully established. This topic will review the clinical significance and differential diagnosis of gallbladder polyps, and will provide a practical approach to their management. Gallbladder cancer is discussed in detail elsewhere. (See "Gallbladder cancer: Epidemiology, risk factors, clinical features, and diagnosis".)

EPIDEMIOLOGY

Gallbladder polyps have been observed in 0.004 to 13.8 percent of resected gallbladders [1], and in 1.5 to 4.5 percent of gallbladders assessed by ultrasonography [2,3]. 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 [3]. Gallbladder polyps have only rarely been described in children, in whom they occur either as a primary disorder or in association with other conditions, including metachromatic leukodystrophy, Peutz-Jeghers syndrome, or pancreatobiliary malunion [4]. (See "Epidemiology of and risk factors for gallstones".)

CLASSIFICATION

The classification of gallbladder polyps was first proposed in 1970 based upon a review of 180 benign tumors [5]. As a general rule, polypoid lesions can be categorized as benign or malignant (table 1) [6,7]. Benign lesions have been further subdivided into neoplastic or non-neoplastic:

The most common benign neoplastic lesion is an adenoma. Benign mesodermal tumors such as leiomyomas and lipomas are rare.

                                 

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Literature review current through: Sep 2014. | This topic last updated: Jan 24, 2014.
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References
Top
  1. Yang HL, Sun YG, Wang Z. Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 1992; 79:227.
  2. Heyder N, Günter E, Giedl J, et al. [Polypoid lesions of the gallbladder]. Dtsch Med Wochenschr 1990; 115:243.
  3. Jørgensen T, Jensen KH. Polyps in the gallbladder. A prevalence study. Scand J Gastroenterol 1990; 25:281.
  4. Stringer MD, Ceylan H, Ward K, Wyatt JI. Gallbladder polyps in children--classification and management. J Pediatr Surg 2003; 38:1680.
  5. Christensen AH, Ishak KG. Benign tumors and pseudotumors of the gallbladder. Report of 180 cases. Arch Pathol 1970; 90:423.
  6. Weedon D. Benign mucosal polyps. In: Pathology of the gallbladder, Mason, New York 1984. p.195.
  7. Laitio M. Histogenesis of epithelial neoplasms of human gallbladder II. Classification of carcinoma on the basis of morphological features. Pathol Res Pract 1983; 178:57.
  8. JUTRAS JA. Hyperplastic cholecystoses; Hickey lecture, 1960. Am J Roentgenol Radium Ther Nucl Med 1960; 83:795.
  9. SALMENKIVI K. CHOLESTEROSIS OF THE GALL-BLADDER. A CLINICAL STUDY BASED ON 269 CHOLECYSTECTOMIES. Acta Chir Scand Suppl 1964; 105:SUPPL 324:1.
  10. FELDMAN M, FELDMAN M Jr. Cholesterosis of the gallbladder; an autopsy study of 165 cases. Gastroenterology 1954; 27:641.
  11. Maccarty WC. IV. The Pathology of the Gall-bladder and some Associated Lesions: A Study of Specimens from 365 Cholecystectomies. Ann Surg 1910; 51:651.
  12. Nishimura A, Shirai Y, Hatakeyama K. Segmental adenomyomatosis of the gallbladder predisposes to cholecystolithiasis. J Hepatobiliary Pancreat Surg 2004; 11:342.
  13. Shepard VD, Walters W, Dockerty MB. Benign neoplasms of the gallbladder. Arch Surg 1942; 45:1.
  14. Jutras JA, Levesque HP. Adenomyoma and adenomyomatosis of the gallbladder, radiologic and pathologic correlations. Rad Clin N Amer 1966; 4:483.
  15. BEAN BC, BERENS DL, CULVER GJ. The relationship of stenosis to Rokitansky Aschoff sinuses of the gallbladder. Am J Roentgenol Radium Ther Nucl Med 1957; 77:47.
  16. King ES, McCallum P. Cholecystitis glandularis Proliferans. Br J Surg 1931; 19:310.
  17. Ootani T, Shirai Y, Tsukada K, Muto T. Relationship between gallbladder carcinoma and the segmental type of adenomyomatosis of the gallbladder. Cancer 1992; 69:2647.
  18. Nabatame N, Shirai Y, Nishimura A, et al. High risk of gallbladder carcinoma in elderly patients with segmental adenomyomatosis of the gallbladder. J Exp Clin Cancer Res 2004; 23:593.
  19. Kim JH, Jeong IH, Han JH, et al. Clinical/pathological analysis of gallbladder adenomyomatosis; type and pathogenesis. Hepatogastroenterology 2010; 57:420.
  20. Kasahara Y, Sonobe N, Tomiyoshi H, et al. Adenomyomatosis of the gallbladder: a clinical survey of 30 surgically treated patients. Nihon Geka Hokan 1992; 61:190.
  21. Kai K, Ide T, Masuda M, et al. Clinicopathologic features of advanced gallbladder cancer associated with adenomyomatosis. Virchows Arch 2011; 459:573.
  22. Maeyama R, Yamaguchi K, Noshiro H, et al. A large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma. J Gastroenterol 1998; 33:770.
  23. Farinon AM, Pacella A, Cetta F, Sianesi M. "Adenomatous polyps of the gallbladder" adenomas of the gallbladder. HPB Surg 1991; 3:251.
  24. Albores-Saaverdra J, Henson DE. Tumors of the gallbladder and the extrahepatic bile duct, 17-25. US Armed Forces Institute of Pathology, Washington, DC 1989.
  25. Kozuka S, Tsubone N, Yasui A, Hachisuka K. Relation of adenoma to carcinoma in the gallbladder. Cancer 1982; 50:2226.
  26. [Collective review of 503 cases of small polypoid lesions (less than 20mm in maximum diameter) of the gallbladder: size distribution in various diseases and the depth of carcinomatous invasion]. Nihon Shokakibyo Gakkai Zasshi 1986; 83:2086.
  27. McGregor JC, Cordiner JW. Papilloma of the gallbladder. Br J Surg 1974; 61:356.
  28. KANE CF, BROWN CH, HOERR SO. Papilloma of the gallbladder; report of eight cases. Am J Surg 1952; 83:161.
  29. Takii Y, Shirai Y, Kanehara H, Hatakeyama K. Obstructive jaundice caused by a cholesterol polyp of the gallbladder: report of a case. Surg Today 1994; 24:1104.
  30. Parrilla Paricio P, García Olmo D, Pellicer Franco E, et al. Gallbladder cholesterolosis: an aetiological factor in acute pancreatitis of uncertain origin. Br J Surg 1990; 77:735.
  31. MITTY WF Jr, ROUSSELOT LM. Cholesterosis of the gall bladder. Gastroenterology 1957; 32:910.
  32. Kmiot WA, Perry EP, Donovan IA, et al. Cholesterolosis in patients with chronic acalculous biliary pain. Br J Surg 1994; 81:112.
  33. Koga A, Watanabe K, Fukuyama T, et al. Diagnosis and operative indications for polypoid lesions of the gallbladder. Arch Surg 1988; 123:26.
  34. Ishikawa O, Ohhigashi H, Imaoka S, et al. The difference in malignancy between pedunculated and sessile polypoid lesions of the gallbladder. Am J Gastroenterol 1989; 84:1386.
  35. Sarkut P, Kilicturgay S, Ozer A, et al. Gallbladder polyps: factors affecting surgical decision. World J Gastroenterol 2013; 19:4526.
  36. Kubota K, Bandai Y, Noie T, et al. How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystectomy? Surgery 1995; 117:481.
  37. Berk RN, van der Vegt JH, Lichtenstein JE. The hyperplastic cholecystoses: cholesterolosis and adenomyomatosis. Radiology 1983; 146:593.
  38. Meacock LM, Sellars ME, Sidhu PS. Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. Br J Radiol 2010; 83:615.
  39. Tsuji S, Sofuni A, Moriyasu F, et al. Contrast-enhanced ultrasonography in the diagnosis of gallbladder disease. Hepatogastroenterology 2012; 59:336.
  40. Li D, Dong BW, Wu YL, Yan K. Image-directed and color Doppler studies of gallbladder tumors. J Clin Ultrasound 1994; 22:551.
  41. Hirooka Y, Naitoh Y, Goto H, et al. Differential diagnosis of gall-bladder masses using colour Doppler ultrasonography. J Gastroenterol Hepatol 1996; 11:840.
  42. Li D. [Color Doppler flow imaging in gallbladder tumors]. Zhonghua Yi Xue Za Zhi 1992; 72:394.
  43. Pradhan S, Shukla VK, Agrawal S, et al. Sonographic and colour doppler morphology in carcinoma gallbladder. Indian J Cancer 2002; 39:143.
  44. Sato M, Ishida H, Konno K, et al. Localized gallbladder carcinoma: sonographic findings. Abdom Imaging 2001; 26:619.
  45. Komatsuda T, Ishida H, Konno K, et al. Gallbladder carcinoma: color Doppler sonography. Abdom Imaging 2000; 25:194.
  46. Hayakawa S, Goto H, Hirooka Y, et al. Colour Doppler-guided spectral analysis of gall-bladder wall flow. J Gastroenterol Hepatol 1998; 13:181.
  47. Jang JY, Kim SW, Lee SE, et al. Differential diagnostic and staging accuracies of high resolution ultrasonography, endoscopic ultrasonography, and multidetector computed tomography for gallbladder polypoid lesions and gallbladder cancer. Ann Surg 2009; 250:943.
  48. Furukawa H, Takayasu K, Mukai K, et al. CT evaluation of small polypoid lesions of the gallbladder. Hepatogastroenterology 1995; 42:800.
  49. Choi JH, Yun JW, Kim YS, et al. Pre-operative predictive factors for gallbladder cholesterol polyps using conventional diagnostic imaging. World J Gastroenterol 2008; 14:6831.
  50. Park KW, Kim SH, Choi SH, Lee WJ. Differentiation of nonneoplastic and neoplastic gallbladder polyps 1 cm or bigger with multi-detector row computed tomography. J Comput Assist Tomogr 2010; 34:135.
  51. Lou MW, Hu WD, Fan Y, et al. CT biliary cystoscopy of gallbladder polyps. World J Gastroenterol 2004; 10:1204.
  52. Sugiyama M, Xie XY, Atomi Y, Saito M. Differential diagnosis of small polypoid lesions of the gallbladder: the value of endoscopic ultrasonography. Ann Surg 1999; 229:498.
  53. Sugiyama M, Atomi Y, Yamato T. Endoscopic ultrasonography for differential diagnosis of polypoid gall bladder lesions: analysis in surgical and follow up series. Gut 2000; 46:250.
  54. Kimura K. [Diagnosis for pedunculated polypoid lesions of the gallbladder by endoscopic ultrasonography]. Nihon Shokakibyo Gakkai Zasshi 1997; 94:249.
  55. Matsumoto J. Endoscopic ultrasonography diagnosis of gallbladder lesions. Endoscopy 1998; 30 Suppl 1:A124.
  56. Azuma T, Yoshikawa T, Araida T, Takasaki K. Differential diagnosis of polypoid lesions of the gallbladder by endoscopic ultrasonography. Am J Surg 2001; 181:65.
  57. Muguruma N, Okamura S, Ichikawa S, et al. Endoscopic sonography in the diagnosis of gallbladder wall lesions in patients with gallstones. J Clin Ultrasound 2001; 29:395.
  58. Park CH, Chung MJ, Oh TG, et al. Differential diagnosis between gallbladder adenomas and cholesterol polyps on contrast-enhanced harmonic endoscopic ultrasonography. Surg Endosc 2013; 27:1414.
  59. Choi JH, Seo DW, Choi JH, et al. Utility of contrast-enhanced harmonic EUS in the diagnosis of malignant gallbladder polyps (with videos). Gastrointest Endosc 2013; 78:484.
  60. Rodríguez-Fernández A, Gómez-Río M, Medina-Benítez A, et al. Application of modern imaging methods in diagnosis of gallbladder cancer. J Surg Oncol 2006; 93:650.
  61. Gurusamy KS, Abu-Amara M, Farouk M, Davidson BR. Cholecystectomy for gallbladder polyp. Cochrane Database Syst Rev 2009; :CD007052.
  62. Patiño JF, Quintero GA. Asymptomatic cholelithiasis revisited. World J Surg 1998; 22:1119.
  63. Terzi C, Sökmen S, Seçkin S, et al. Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery 2000; 127:622.
  64. Buckles DC, Lindor KD, Larusso NF, et al. In primary sclerosing cholangitis, gallbladder polyps are frequently malignant. Am J Gastroenterol 2002; 97:1138.
  65. Chapman R, Fevery J, Kalloo A, et al. Diagnosis and management of primary sclerosing cholangitis. Hepatology 2010; 51:660.
  66. Eaton JE, Thackeray EW, Lindor KD. Likelihood of malignancy in gallbladder polyps and outcomes following cholecystectomy in primary sclerosing cholangitis. Am J Gastroenterol 2012; 107:431.
  67. Razumilava N, Gores GJ, Lindor KD. Cancer surveillance in patients with primary sclerosing cholangitis. Hepatology 2011; 54:1842.
  68. Schramm C, Lohse AW. Gallbladder polyps in primary sclerosing cholangitis: indication for early intervention. Hepatology 2012; 56:396; author reply 396.
  69. American Society for Gastrointestinal Endoscopy (ASGE) Standards of Practice Committee, Anderson MA, Appalaneni V, et al. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointest Endosc 2013; 77:167.
  70. Koga A, Yamauchi S, Nakayama F. Primary carcinoma of the gallbladder. Am Surg 1985; 51:529.
  71. Park JY, Hong SP, Kim YJ, et al. Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol 2009; 24:219.
  72. Corwin MT, Siewert B, Sheiman RG, Kane RA. Incidentally detected gallbladder polyps: is follow-up necessary?--Long-term clinical and US analysis of 346 patients. Radiology 2011; 258:277.
  73. Pedersen MR, Dam C, Rafaelsen SR. Ultrasound follow-up for gallbladder polyps less than 6 mm may not be necessary. Dan Med J 2012; 59:A4503.
  74. Yamamoto T. [A study of cholesterol gallstone formation in cases of cholesterolosis of the gallbladder (author's transl)]. Nihon Shokakibyo Gakkai Zasshi 1979; 76:91.