Gallbladder polyps are growths or lesions resembling growths (polypoid lesions) in the wall of the
gallbladder
In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, althoug ...
. True
polyps
A polyp in zoology is one of two forms found in the phylum Cnidaria, the other being the medusa. Polyps are roughly cylindrical in shape and elongated at the axis of the vase-shaped body. In solitary polyps, the aboral (opposite to oral) end ...
are abnormal accumulations of mucous membrane tissue that would normally be shed by the body.
Signs and symptoms
Most polyps do not cause noticeable symptoms. Gallbladder polyps are usually found incidentally when examining the abdomen by ultrasound for other conditions, usually abdominal pain.
Pathology
Most small polyps (less than 1 cm) are not cancerous and may remain unchanged for years.
However, when small polyps occur with other conditions, such as
primary sclerosing cholangitis
Primary sclerosing cholangitis (PSC) is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts, which normally allow bile to drain from the gallbladder. Affected individuals may ...
, they are less likely to be benign.
Larger polyps are more likely to develop into
adenocarcinomas.
Cholesterolosis is characterized by an outgrowth of the mucosal lining of the gallbladder into fingerlike projections due to the excessive accumulation of
cholesterol
Cholesterol is any of a class of certain organic molecules called lipids. It is a sterol (or modified steroid), a type of lipid. Cholesterol is biosynthesized by all animal cells and is an essential structural component of animal cell membr ...
and
triglycerides
A triglyceride (TG, triacylglycerol, TAG, or triacylglyceride) is an ester derived from glycerol and three fatty acids (from ''tri-'' and '' glyceride'').
Triglycerides are the main constituents of body fat in humans and other vertebrates, as ...
within
macrophages
Macrophages (abbreviated as M φ, MΦ or MP) ( el, large eaters, from Greek ''μακρός'' (') = large, ''φαγεῖν'' (') = to eat) are a type of white blood cell of the immune system that engulfs and digests pathogens, such as cancer ce ...
in the epithelial lining.
These cholesterol polyps account for most benign gallbladder polyps.
Adenomyomatosis describes a diseased state of the gallbladder in which the gallbladder wall is excessively thick, due to proliferation of subsurface cellular layer. It is characterized by deep folds into the
muscularis propria
The muscular layer (muscular coat, muscular fibers, muscularis propria, muscularis externa) is a region of muscle in many organs in the vertebrate body, adjacent to the submucosa. It is responsible for gut movement such as peristalsis. The Latin, ...
. Ultrasonography may reveal the thickened gallbladder wall with
intramural diverticulae, called Rokitansky-Aschoff sinuses.
Diagnosis
Diagnosis is typically by ultrasound or CT imaging.
Upon
histopathology
Histopathology (compound of three Greek words: ''histos'' "tissue", πάθος ''pathos'' "suffering", and -λογία '' -logia'' "study of") refers to the microscopic examination of tissue in order to study the manifestations of disease. Sp ...
of resected gallbladders, gallbladder polyps may be classified into the following main types:
[ ]
* Non-neoplastic polyps: Cholesterol, hyperplastic, and inflammatory polyps, adenomyomas, leiomyomas, fibromas, and lipomas
* Neoplastic polyps: adenomas, adenocarcinomas, and squamous cell carcinomas
File:Gallbladder polyps 110739484 cr.jpg, Ultrasound image of gallbladder polyps measuring 3–7 mm.
File:Gallbladder polyp types by relative incidence.jpg, Gallbladder polyp types by relative incidence.Histopathology
Histopathology (compound of three Greek words: ''histos'' "tissue", πάθος ''pathos'' "suffering", and -λογία '' -logia'' "study of") refers to the microscopic examination of tissue in order to study the manifestations of disease. Sp ...
of a hyperplastic polyp: There is no dysplasia
Dysplasia is any of various types of abnormal growth or development of cells ( microscopic scale) or organs (macroscopic scale), and the abnormal histology or anatomical structure(s) resulting from such growth. Dysplasias on a mainly microscopi ...
.
Treatment
Most polyps are benign and do not need to be removed. Surgical removal of the gallbladder (
cholecystectomy
Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed i ...
) is recommended when a gallbladder polyp larger than 1 cm is found, even if the person has no symptoms clearly related to the polyp.
Laparoscopic surgery
Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medl ...
is an option for small or solitary polyps.
Epidemiology
Polypoid lesions of the gallbladder affect approximately 5% of the adult population.
The causes are uncertain, but there is a definite correlation with increasing age and the presence of
gallstones
A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of ...
(
cholelithiasis
A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of mi ...
). Most affected individuals do not have symptoms. The gallbladder polyps are detected during abdominal ultrasonography performed for other reasons.
The incidence of gallbladder polyps is higher among men than women. The overall prevalence among men of Chinese ancestry is 9.5%, higher than other ethnic types.
References
External links
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Abdomen
Gallbladder disorders
Hepatology