Index
There are particular organs without which one can not survive a few minutes, like the brain. But specific organs, such as the gallbladder, can be removed safely.
The gallbladder even being essential to perform several functions; however, eliminating it permanently through a laparoscopic surgery of the gallbladder does not endanger the life of the individual.
Gallbladder polyps are extensions or elevations of the gallbladder wall that project into the mucosa of the gallbladder. They are usually detected or commonly found, incidentally, in abdominal ultrasounds.
They can also be found after analyzing the gallbladder sample after cholecystectomy. More high-quality ultrasounds are performed means that polyps in the gallbladder are found more frequently.
When detected on ultrasound, its clinical importance is primarily related to its malignant potential. Most of these lesions are not neoplastic, but they are hyperplastic or represent lipids (cholesterolosis) deposits.
Imaging studies alone are not specific enough to exclude the possibility of gallbladder carcinoma or premalignant adenomas. In addition, even benign lesions can occasionally lead to symptoms similar to those caused by gallbladder stones.
Although the widespread use of ultrasound has made the diagnosis of polypoid lesions of the gallbladder increasingly frequent, the optimal strategies for evaluating these lesions have not been fully established.
This topic will review the clinical importance and differential diagnosis of gallbladder polyps and provide a practical approach to their treatment. Gallbladder cancer is discussed in detail elsewhere.
Most of these lesions are not cancerous but contain normal cells or represent fatty deposits (cholesterolosis). Cholecystectomy is sometimes recommended to exclude the possibility of gallbladder carcinoma or precancerous polyps.
Sometimes, gallbladder polyps can cause symptoms caused by gallbladder stones.
How Common Are Biliary Vesicle Polyps?
Gallbladder polyps are found in approximately 3% of people who have an ultrasound of their gallbladder.
How are biliary vesicle polyps grouped?
The most common benign polyp is an adenoma; the risk of an adenoma becoming cancerous is related to the size of the polyp.
Pseudopolyps (which are not polyps) are the most common findings that resent cholesterol deposits in the wall cholesterolosis) or adenomas (cholesterol deposits in the wall with inflammation).
The most common cancerous lesion in the gallbladder is adenocarcinoma. Adenocarcinomas of the gallbladder are much more common than gallbladder adenomas.
What are the Symptoms of Biliary Vesicle Polyps?
Gallbladder polyps usually do not produce any symptoms, but the presence of symptoms similar to the gallbladder, without another explanation, is a reason to remove the gallbladder.
What is the Risk of Cancer in a Biliary Vesicle Polyp?
The risk of cancer increases with the size of the polyp. If a polyp measures more than 1 cm, it is generally recommended to remove it to exclude the cancerous change.
Diagnosis
Ultrasound: Modern ultrasound produces excellent gallbladder images and can measure the blood flow in a polyp.
Computed tomography scan: performed for large polyps and if gallbladder cancer is suspected.
What is the Treatment for Biliary Vesicle Polyps?
The only effective treatment for gallbladder polyps or cholesteroliasis is cholecystectomy, which should be considered in patients with symptoms or to exclude cancerous changes in large polyps (this can only be done by examining the gallbladder with a microscope).
However, very few gallbladder cancers will be found in polyps less than 1 cm. For patients without symptoms, the treatment depends on the size:
- Large polyps larger than 2 cm require an extended cholecystectomy: sampling the lymph nodes and the adjacent liver. This is done as an open procedure.
- Polyps between 1 and 2 cm require a careful cholecystectomy to remove all the tissue from the gallbladder. This can be done as a laparoscopic procedure.
- Polyps less than 1 cm can usually be re-evaluated with an ultrasound after six months and then every year (if the size remains the same).
- Polyps less than 5 mm must undergo a single ultrasound every year (if the size is stable).
For patients with symptoms, cholecystectomy is recommended if no other cause of pain is found. Still, patients should know that small polyps are less likely to be the cause of the symptoms and, therefore, it is possible that the symptoms do not improve if the gallbladder is removed.
Results
The management of gallbladder polyps detected incidentally in radiological examinations is controversial. The incidental radiological finding of a gallbladder polyp can be problematic for the radiologist and the doctor who referred the patient for radiological analysis.
Epidemiology
In one report, no association was observed between polyps and age, sex, weight, number of pregnancies, the use of exogenous female hormones, or any other risk factor that is generally thought to be associated with gallstones.
Gallbladder polyps have rarely occurred in children. They present as a primary disorder or are associated with other conditions, such as metachromatic leukodystrophy, Peutz-Jeghers syndrome, or defective pancreaticobiliary junction.
Classification
The classification of gallbladder polyps was proposed for the first time in 1970 based on a review of 180 benign tumors. Generally, polypoid lesions can be categorized as benign or malignant.
Gallbladder polyps can be divided into pseudopolyps and true gallbladder polyps.
Pseudopolyps are more common than true polyps. 70% of suspected gallbladder polyps were pseudopolyps. Pseudopolyps are more commonly cholesterol pseudopolyps and include focal adenomatosis and inflammatory pseudopolyps.
The pseudopolyps do not have in themselves a malignant potential. The true polyps of the gallbladder can be benign or malignant. Benign polyps are more commonly adenomas, while malignant polyps are usually adenocarcinomas.
There are rarely benign and malignant gallbladder polyps, including mesenchymal tumors, lymphoma, and metastasis.
Unlike the adenoma-carcinoma sequence that is well described for colon polyps, the line of adenoma-carcinoma in the gallbladder is less known.
However, the evidence that exists suggests that at least some adenocarcinomas of the gallbladder have arisen in pre-existing adenomas and, as such, the adenoma-carcinoma sequence is likely, at least in some cases.
Pathophysiology
Cholesterol polyps
Cholesterol polyps account for approximately 50% of all gallbladder polypoid lesions. It is believed that these lesions originate from a defect in cholesterol metabolism.
They appear as yellow spots on the mucosal surface of the gallbladder. They are identified histologically as epithelial-covered macrophages loaded with triglycerides and sterols esterified in the lamina propria of the mucosal layer of the gallbladder.
As a rule, cholesterol polyps exist as multiple lesions and are usually smaller than 10 mm. They are generally asymptomatic.
Inflammatory polyps
These injuries are the result of chronic inflammation. They extend into the light of the gallbladder through a narrow vascularized stem.
Adenomatosis
Extensions of the Rokitansky-Aschoff breasts characterize adenomatosis through the muscular wall of the gallbladder. Ultrasound reveals a thickened wall of the gallbladder with intramural diverticula.
Although adenomatosis is generally considered a benign condition, a serial ultrasound evaluation is recommended to rule out adenomatous polyps and gallbladder cancer enlargement.
Some authors have reported that gallbladder cancer occurs in localized adenomatosis and have suggested a more aggressive approach for these benign lesions.
Adenomatous polyps
Adenomatous polyps are benign epithelial neoplasms with malignant potential. Papillary adenomas grow as pedunculated, complex, and branched tumors that project into the lumen of the gallbladder.
Tubular adenomas arise as flat and sessile neoplasms. Consequently, it can be difficult to distinguish some adenomas from other gallbladder polyps using ultrasound.
Adenomatous polyps are found in about 1% of cholecystectomy samples.
Conclusions
These expert consensus recommendations can be used as a guide when a vesicular polyp is found in clinical practice.
Most polyps are composed of cholesterol and are potentially harmless. However, diagnosing and dealing with it can be pretty tricky.
While some of the polyps cause abdominal pain, others may not show significant symptoms, which makes the diagnosis challenging.
Although some polyps disappear independently, some are dangerous and should be surgically operated on. Another type stays for a long time, usually up to whole life. It becomes a doubt, either to eliminate it or follow it; if so, for how long?
