Diagnosis and treatment of polypoid lesions of the gallbladder:report of 194 cases

BACKGROUND: With the wide use of B-ultrasonography in recent years, the polypoid lesion of the gallbladde ( PLG) has been one of the most common diseases detected in biliary surgery. This study was to investigate the diag nostic method and operative indications of PLG. METHODS: The clinical and pathological data of 194 pa tients with PLG who had received operation at our hospita from January 1994 to September 2002 were analyzed retro spectively. Categorized data were analyzed by the chi square test. RESULTS: All the patients received preoperative B-ultra- sonography. 185 of the 194 PLG patients were diagnosed as having cholecystic polyp, and 9 adenomas. Among the 42 patients who received CT, 6 showed early gallbladder can cer. Pathologically, cholesterol polyps were mostly multi ple lesions (64.7%) with a mean diameter of3.86±2.2 mm in 136 patients. Of 16 patients with adenomas, 10 had a tumor diameter of more than 10 mm (62.5%). In 11 pa tients with gallbladder carcinoma, 7 were accompanied with gallbladder stone (63.6%). In addition, inflammatory polyps and adenomyomas were found in 25 and 6 patients respectively. CONCLUSIONS: B-ultrasonography is the most effective diagnostic method for detecting PLG. When large or irreg- ular lesions are found, CT should be performed in order to avoid missing of gallbladder carcinoma. Operative indica- tions for PLG include; a maximal tumor diameter of more than 10 mm; an over 50-year-old patient with a wide-base and a single polyp lesion; a wide-base lesion or a lesion showing a tendency to enlargement; co-existing gallbladder stone or cholecystitis; a patient without other diseases but obvious clinical features and failure of general ma- nagement ; big or long pedicels or polyps at the neck of the gallbladder for preventing the empty of the gallbladder and a history of biliary colic; and PLG with irregularly thick- ened local gallbladder wall.

Primary melanoma of the gallbladder: Does it exist? Report of a case and review of the literature

With the occasion of a case of malignant melanoma of the gallbladder, which appeared to be primary, we have reviewed the literature and the result of this research was that primary melanoma of the gallbladder remains a questionable medical entity. Only few cases of both primary and metastatic gallbladder melanoma have been reported so far, and the only agreement is that surgery is the mainstaytreatment. The role of adjuvant chemotherapy, hormonotherapy or immunotherapy for both primary and metastatic disease remains undefined.

Importance of accurate diagnosis of congenital agenesis of the gallbladder from atypical gallbladder stone presentations:A case report

BACKGROUND Congenital agenesis of the gallbladder(CAGB)is a rare condition often misdiagnosed as cholecystolithiasis,leading to unnecessary surgeries.Accurate diagnosis and surgical exploration are crucial in patients with suspected CAGB or atypical gallbladder stone symptoms.Preoperative imaging,such as magnetic resonance cholangiopancreatography(MRCP),plays a vital role in confirming the diagnosis.Careful intraoperative dissection is necessary to avoid iatrogenic injuries and misdiagnosis.Multidisciplinary consultations and collaboration,along with the use of various diagnostic methods,can minimize associated risks.CASE SUMMARY We present the case of a 34-year-old female with suspected gallbladder stones,ultimately diagnosed with CAGB through surgical exploration.The patient underwent laparoscopic examination followed by open exploratory surgery,which confirmed absence of the gallbladder.Subsequent imaging studies supported the diagnosis.The patient received appropriate postoperative care and experienced a successful recovery.CONCLUSION This case highlights the rarity of CAGB and the importance of considering this condition in the differential diagnosis of patients with gallbladder stone symptoms.Accurate diagnosis using preoperative imaging,such as MRCP,is crucial to prevent unnecessary surgeries.Surgeons should exercise caution and conduct meticulous dissection during surgery to avoid iatrogenic injuries and ensure accurate diagnosis.Multidisciplinary collaboration and utilization of various diagnostic methods are essential to minimize the risk of misdiagnosis.Selection of the optimal treatment strategy should prioritize minimizing trauma and maintaining open communication with the patient and their family members.

PATHOLOGIC STUDY OF PRECANCEROUS LESION OF THE GALLBLADDER

Precancerous lesions of the gallbladder in 150 consecutive cholecystectomy specimens resected from the patients with cholelithiasis or cholecystitis were studied. Of these specimens, 80% had simple epithelial hyperplasia, 16% atypical hyperplasia, 1.3% carcinoma in situ and 2.7% invasive carcinoma. Atypical hyperplasia was observed in the mucosa abjacent to carcinoma in situ which, in turn, was found in the mucosa adjacent to invasive carcinoma. This finding suggests that some of simple hyperplasia of the gallbladder evolve towards atypical hyperplasia, carcinoma in situ which finally becomes invasive carcinoma. In addition, the authors provide a morphologic criteria for grading the atypical hyperplasia of the gallbladder.

Imaging-based algorithmic approach to gallbladder wall thickening

Gallbladder(GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma(GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities(conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.

Volvulus of the gall bladder diagnosed by ultrasonography,computed tomography,coronal magnetic resonance imaging and magnetic resonance cholangio-pancreatography

A 54-year-old woman was admitted to our hospital with the complaint of right upper quadrant pain. Upon physical examination the vital signs of the patient were within normal ranges. Ultrasonography and computed tomography （CT） examination of the abdomen was obtained, which demonstrated a large dilatated cystic structure, measuring approximately 68.6 mm × 48.6 mm, with marked distension and inflammation. Additionally, the enhanced CT was characterized by the non-enhanced wall of the gallbladder. As the third examination in this study, magnetic resonance imaging （MRI）, namely coronal MRI and magnetic resonance cholangio-pancreatography （MRCP）, were performed. The MRCP demonstrated a dilatation of the gallbladder but detected no neck of the gallbladder. Simple cholecystectomy was performed. Macroscopic findings included a distended and gangrenous gallbladder, and closer examination revealed a counterclockwise torsion of 360 degrees on the gallbladder mesentery. Coronal MRI and MRCP showing characteristic radiography may be useful in making a definitive diagnosis.