Journal Article•
Benign tumors and pseudotumors of the gallbladder. Report of 180 cases.
About: This article is published in Archives of pathology.The article was published on 1970-11-01 and is currently open access. It has received 280 citations till now. The article focuses on the topics: Gallbladder Neoplasm & Gallbladder polyp.
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TL;DR: In the clinical setting of a patient with nonspecific abdominal complaints or symptoms of biliary obstruction, the discovery of a gallbladder or bile duct polyp or mass, gallbladders wall thickening, or biliary stricture is most often indicative of malignancy, but the differential diagnosis should include benign tumors and tumorlike lesions.
Abstract: A diverse spectrum of benign tumors and tumorlike lesions arises from the gallbladder and bile ducts, and despite their diversity, these lesions share common embryologic origins and histologic characteristics. Although these lesions are relatively uncommon, their importance lies in their ability to mimic malignant lesions in these locations. Benign neoplasms are derived from the epithelial and nonepithelial structures that compose the normal gallbladder and bile ducts. The epithelium gives rise to adenomas, cystadenomas, and the unusual condition of biliary papillomatosis. Granular cell tumors, neurofibromas, ganglioneuromas, paragangliomas, and leiomyomas are examples of benign tumors that may originate from nonepithelial structures. Tumorlike lesions are more commonly found in the gallbladder and include xanthogranulomatous cholecystitis, adenomyomatous hyperplasia, cholesterol polyps, and heterotopias. In the clinical setting of a patient with nonspecific abdominal complaints or symptoms of biliary obstruction, the discovery of a gallbladder or bile duct polyp or mass, gallbladder wall thickening, or biliary stricture is most often indicative of malignancy. However, the differential diagnosis should include benign tumors and tumorlike lesions. The preoperative determination of a benign lesion may significantly alter therapy and patient prognosis.
759 citations
TL;DR: Transition of benign adenoma into carcinoma was histologically traceable and Adenomatous residue was found in 15 (19.0%) of 79 cases of invasive carcinoma.
Abstract: In order to clarify the relation of adenoma to carcinoma in the gallbladder, histopathologic examination was made on surgical specimens of 1605 cholecystectomies. Among them, 11 benign adenomas, seven adenomas with malignant change, and 79 invasive carcinomas were found. All of the benign adenomas were 12 mm or less in diameter (average diameter, 5.5 +/- 3.1 mm), while the adenomas having cancerous foci were 12 mm or more in diameter (average diameter, 17.6 +/- 4.4 mm). Most invasive carcinomas were more than 30 mm in diameter. The average patient age was 50.5 +/- 16.3 years for benign adenomas, 58.3 +/- 12.6 years for adenomas with malignant change, and 64.8 +/- 9.6 years for invasive carcinomas. Transition of benign adenoma into carcinoma was histologically traceable. Adenomatous residue was found in 15 (19.0%) of 79 cases of invasive carcinoma.
268 citations
TL;DR: The size and number of PLG, the presence of gallstones and the patient's age all correlate with the nature ofPLG, and these features are helpful in differentiating malignant from benign lesions before operation, which has now become entirely dependent on ultrasonography.
Abstract: One hundred and eighty-two patients with an ultrasonographic and/or pathological diagnosis of polypoid lesions of the gallbladder (PLG) were reviewed to determine the reliability of ultrasonography in the diagnosis of PLG and the indications for operation in this disease. Of the 182 patients operated on, PLG were demonstrated by the gross appearance of the resected gallbladder in 172. Histologically benign lesions were present in 159 gallbladders and malignant lesions in 13. Cholesterol polyps accounted for most benign PLG. The sensitivity of ultrasonography in detecting PLG was 90.1 per cent, significantly higher than that of oral cholecystography, computed tomography or endoscopic retrograde cholangiopancreatography (P less than 0.01). The specificity of ultrasonography in the diagnosis of PLG was 93.9 per cent. Therefore, ultrasonography is a highly sensitive method for investigating PLG, and the preoperative diagnosis of PLG in this unit has now become entirely dependent on this technique. The size and number of PLG, the presence of gallstones and the patient's age all correlate with the nature of PLG, and these features are helpful in differentiating malignant from benign lesions before operation. Surgical treatment is indicated when PLG exceed 1.0 cm in diameter, when PLG are single in number, when PLG are associated with gallstones, when patients with PLG are over the age of 50 years, or when clinical symptoms of PLG are apparent.
236 citations
TL;DR: In this paper, a review was done by Medline search of the English literature by the keywords "polypoid lesions of gallbladder,” "gallbladder polyps", "carcinoma of gall-bladder", and "benign tumors of gall -bladder".
Abstract: Background Polypoid lesions of the gallbladder encompass a wide variety of pathology. Although most of these lesions are benign, some early carcinomas of the gallbladder do present as polypoid lesions. Problems remain in selecting patients with polypoid lesions of the gallbladder for surgery, the operative approach, and the method of follow-up of those deemed not needing surgery. Data sources This review was done by Medline search of the English literature by the keywords “polypoid lesions of gallbladder,” “gallbladder polyps,” “carcinoma of gallbladder,” and “benign tumors of gallbladder.” Conclusions Most small polypoid lesions of the gallbladder are benign and remain static for years. Three- to six-monthly ultrasonography examination is warranted in the initial follow-up period but it is probably unnecessary after 1 or 2 years. Age more than 50 years and size of polyp more than 1 cm are the two most important factors predicting malignancy in polypoid lesions of the gallbladder. Other risk factors include concurrent gallstones, solitary polyp, and symptomatic polyp. Laparoscopic cholecystectomy is the treatment of choice unless the suspicion of malignancy is high, in which case it is advisable to have open exploration, intraoperative frozen section, and preparation for extended resection.
216 citations
TL;DR: The risk factors for malignancy were the age of the patient, the coexistence of gallstones, and the size of the polypoid lesions (>10 mm in diameter), and in asymptomatic patients, cholecystectomy can be justified if there are risk Factors for Malignancy.
202 citations