Polyp itself is not itchy, the main reason why people have “prejudice” against polyps is because they are worried about polyp malignancy. It is true that some gallbladder cancers originate from the malignant change of gallbladder polyps. But in fact, there is a difference between “gallbladder polyps” or gallbladder polyp-like changes on the ultrasound report and the polyps that will really become malignant. A gallbladder polyp or polypoid lesion is a general term, generally speaking, the ultrasound report describes a “polypoid lesion of the gallbladder”. This is the name under the imaging examination, the pathological examination is the gold standard to determine whether the gallbladder polyp is good or bad, but the imaging characteristics can generally determine the benignity and malignancy.
The most common clinical findings are simple polyps and non-cholesterol benign polyps, and only a very small percentage of people are found to have polypoid early gallbladder adenocarcinoma.
Cholesterol polyps
More than half of the gallbladder polyps detected by ultrasound are of this type. To be precise, these are not true polyps, but are thought to be cholesterol crystals forming on the mucosal surface of the gallbladder or causing mucosal elevation, hence the term pseudopolyp. The current theory is that these polyps are not cancerous. Cholesterol polyps have the following characteristics: multiple, easily dislodged, mostly within 1 cm, mulberry-like in appearance, brittle and fragile, with a thin tip like cotton thread, and mostly located in the body of the gallbladder. Cholesterol polyps are related to diet, and patients with high cholesterol diet or fatty liver are prone to get cholesterol polyps.
No special treatment is needed for cholesterol polyps. It is recommended that: regular diet, breakfast, low cholesterol diet, and medications can be tried. For cholesterol polyps less than 1 cm, regular ultrasound review every 6 months to a year to observe the changes in size, shape and number can be done.
Non-cholesterol benign polyps
Also known as true polyps, they are a piece of “meat” that actually grows from the wall of the gallbladder, including gallbladder adenoma, adenomyoma, inflammatory polyp, adenomatous hyperplasia, etc. Inflammatory polyps are formed by long-term gallbladder stone irritation combined with chronic cholecystitis. Gallbladder adenoma is a benign tumor adenomyosis and adenomatous hyperplasia also have the risk of cancer.
The ultrasound description will usually include whether the polyp has a wide or narrow base and whether it has a blood supply. Polyps with a blood supply are mostly papillomas or adenomas, which have a risk of cancer. If further clarification of the type and nature of the polyp is needed, enhanced CT or MRI enhancement scans are feasible to help with the diagnosis. In this type of patients, medication is ineffective, and biliary preservation and medication are not recommended for those with a high propensity for malignant transformation, and cholecystectomy is recommended.
Polyps type early gallbladder adenocarcinoma
A small number of patients with adenomatous gallbladder polyps diagnosed on ultrasound end up with adenocarcinoma on postoperative pathology, in fact, this type is strictly speaking no longer in the category of what we call gallbladder polyps. At present, it is sometimes difficult to identify polypoid early gallbladder cancer mixed with gallbladder polyps by ultrasound alone, and if necessary, thin enhancement CT or MRI enhancement scan should be done. The ultrasound characteristics of cancerous polyps are as follows: about 80% of them are larger than 1 cm and solitary; about 70% are located in the neck of gallbladder; about half are accompanied by gallbladder stones. Once such a lesion is suspected, it should be treated surgically as soon as possible.
The gold standard for diagnosis is pathological diagnosis under the microscope. The nature of polyps cannot be determined directly under ultrasound, but can only be inferred empirically, so the term “gallbladder polyp” reported under ultrasound is usually a general term. However, ultrasound usually describes the nature, whether it is multiple or single, size, etc.
How can we generally determine the benign and malignant tendencies of polyps from the report?
In short: rapid growth in a short time; larger than 1 cm; solitary; broad-based; gallbladder polyps; with local or whole gallbladder wall thickening; combined with gallbladder stones chronic cholecystitis; ultrasound, CT and MRI do not exclude the possibility of cancer. From clinical experience, polyps with these characteristics have a high tendency to be “malignant”, and surgery is usually recommended before malignant transformation.
Gallbladder polyps are a common disease and should not be overly worried nor careless.
From clinical experience, in general, multiple polyps may be better than single polyps, most of which are benign cholesterol polyps; while if they are single, we should be highly alert. If it is multiple less than 1 cm, the patient is advised to observe it, but not just leave it alone. Ultrasound is done about half a year, and it is most important to improve the lifestyle and diet during the observation period. If you have uncomfortable symptoms, you can try to take some drugs to relieve the symptoms. It is generally believed that multiple gallbladder polyps less than 1 cm in diameter can be suspended without surgery.
There are two aspects to consider whether to treat gallbladder polyps surgically, on the one hand, to prevent cancer or cancer leakage, which mainly refers to the latter two types of polyps. On the other hand, if the uncomfortable symptoms are not relieved by medication, secondary chronic cholecystitis affects normal work and life, and other factors such as gastric disease can be excluded to consider gallbladder removal.
What are the symptoms of gallbladder polyps?
Gallbladder polyps usually have mild symptoms or even no symptoms. A few patients have upper abdominal discomfort, which may be accompanied by abdominal pain, discomfort or pain in the right upper abdomen or right quarter rib area, a few may be accompanied by radiation to the right shoulder and back. Polyps located in the neck of gallbladder can appear biliary colic, and in combination with stones, there can be biliary colic attacks and acute and chronic inflammatory attacks.
Can I take medicine to treat gallbladder polyps?
For multiple cholesterol polyps, some medications may provide some relief from the symptoms of combined chronic cholecystitis and may have some effect on some cholesterol crystals smaller than 5 mm or to prevent new ones. Medications are not effective for true polyps.
How are gallbladder polyps examined and reviewed?
In most cases, ultrasound is able to determine early on whether something in the gallbladder is a stone or a polyp, and is even more sensitive than CT and MRI for the number, shape and size. However, to further clarify the type and nature of the polyp, especially the latter two types mentioned above, a thin-enhanced CT or MRI-enhanced scan may be needed to help with the diagnosis. Admittedly, sometimes these tests are not 100% definitive and require the physician’s judgment in the context of the patient’s condition. Sometimes the nature of the polyp cannot be determined, and even ultrasound needs to be repeated once every 3 months for close observation.
All in all, surgery is recommended for those with clear malignant tendency, one is clear, and the other is to block the possibility of malignancy; for those without malignant tendency, active surgery is not recommended, and a review can be scheduled for six months to a year according to the specific situation.