Many people find polypoid lesions in the gallbladder during a physical examination. A polypoid lesion is a confined, polypoid, or bulging lesion that protrudes into the gallbladder and is an imaging description rather than a final diagnosis. Ultrasound examination of gallbladder adenomas and cholesterol deposits in the gallbladder wall often show polypoid lesions (adenomyosis of the gallbladder and gallbladder cancer behave differently).
I. Ultrasound typing of gallbladder proliferative disease
It can be divided into four types.
Type I: rice-shaped or mulberry-shaped, with uniform echogenicity, mostly cholesterol polyps.
Type II: single or branching papillary echogenic lesions, mostly cholesterol polyps, but sometimes they can be gallbladder cancer.
Type III: Myxoid parenchymal echogenicity, mostly adenoma, may be gallbladder cancer.
Type IV: irregularly elevated substantial echogenicity, with a high possibility of malignancy, even if the lesion is small, it is highly suspected to be malignant.
Clinical classification of gallbladder proliferative diseases
Classification I (Gallbladder non-stone disease)
1.Gallbladder polypoid lesion
2.Gallbladder adenomyosis
3.Gallbladder cancer
Classification II
1.Cholesterol polyp, also known as cholesterol deposition, accounts for
2.Benign non-cholesterol polypoid lesions account for
3.Polypoid early gallbladder cancer accounts for
Polypoid lesion of gallbladder (PLG)
I. Classification
1.Neoplastic: adenoma of gallbladder (literature reports that the cancer rate is 6%~36%)
2, non-neoplastic: cholesterol polyps, inflammatory polyps, yellow granulomas, ectopic gastric mucosa, ectopic pancreatic tissue
Second, the clinical manifestations
1, mostly asymptomatic, some patients showed right upper abdominal discomfort, vague pain, abdominal distension, etc. Ultrasound: preferred, the core is to identify adenomatous polyps and non-adenomatous polyps. The detection rate is 92.7%, specificity is 94.8%, false positive rate is 5.2%; the characteristics of these polyps are: most of them are less than 10mm, multiple, mostly found in the gallbladder headquarters, fine tips are visible, and faint acoustic shadow is seen in cholesterol-rich polyps.
2, cholesterol-like polyps: multiple small polyps, one or more 0.2-0.5cm diameter constant intensity and sparse light groups on the wall of the gallbladder, not moving, no acoustic shadow; sometimes the polyps are seen with cholesterol-like core.
3, adenomatous polyp: with a tip, single, diameter > 10mm, surface lobulation
C. Treatment
1.No drugs to prevent and disappear
2.Surgery
Surgical indications
1.Diameter
2.Age > 60 years old
3, with gallstone coexistence or polyps rapidly increasing, where the size of polyps is the key factor to decide whether to operate
The current trend of treatment for this type of lesion is mainly conservative treatment, regular (3-6 months) review ultrasound, dynamic observation of changes in the condition, such as the following cases, surgery is required: the diagnosis of doubt, the emergence of obvious clinical symptoms, combined gallbladder stones, lesions significantly enlarged.
Ultrasound follow-up is recommended for patients who do not need surgery for the time being (there is no uniform standard for the follow-up period, some reports suggest that PLG < 5mm should be followed up by ultrasound once a year, and for 5-10 mm diameter, once every 3-6 months)
Adenomyomatosis of gallbladder (Adenomyomatosis of gallbladder)
I. Classification
Clinical manifestations and diagnosis
Symptoms are not specific and similar to cholecystitis and cholelithiasis, and mostly coexist with both
The diagnosis can be made by finding R-A sinus on imaging examination, and the gallbladder is hypercontracted in patients with adenomyomatosis after eating.
1, diffuse type (diffuse thickening of the entire gallbladder wall)
2.Segmental type (the middle part of the thickened gallbladder wall has a circular narrowing, which separates the gallbladder into two small interconnected cavities, so that the gallbladder resembles a gourd).
3.Confined, also known as basal type (limited hyperplasia of the cystic wall at the base of the gallbladder), this type is more common. It is not easy to make a diagnosis before surgery and is considered a precancerous lesion.
Clinical manifestations and diagnosis
Differential diagnosis.
Limited type: associated with gallbladder cancer and gallbladder polyps
Diffuse type: with chronic cholecystitis
Segmental type: congenital septum of gallbladder, distortion and folding of gallbladder
Treatment
Surgical indications (there is no uniform standard yet)
1. Some scholars believe that adenomyosis of the gallbladder is a precancerous lesion of gallbladder cancer, and it is easily complicated by gallbladder stones, so it should be operated immediately upon diagnosis
2.Some scholars believe that suspected cancer or combined with stones is an indication for surgery
3.Problem: Confirmation of diagnosis ultimately depends on pathology, and preoperative diagnosis is difficult
Non-inflammatory thickening or irregular thickening of the gallbladder wall > 5 mm under ultrasound should be highly suspected of adenomyosis of the gallbladder.
Gallbladder cancer (gallbladder cancer)
I. Classification
Papillary, nodular and infiltrative types
Mostly located at the base and neck of gallbladder
The first two types are bulging lesions, while the majority of papillary adenocarcinomas are confined to the mucosal and muscular layers, with good prognosis.
Clinical manifestations and diagnosis
Lack of specificity, the most common symptom is right upper abdominal pain
Imaging: Irregular contour of gallbladder, thickened wall, nodule-like or cauliflower-like elevation
Ultrasound is preferred, and endoscopic ultrasound can determine the degree of tumor infiltration, area and the presence of lymph node metastasis
MRI: enlarged or shrunken gallbladder, irregular thickening of the wall, enhancement, adjacent liver invasion
Ultrasound imaging of the epigastrium is characterized by: tumor larger than 10mm, especially larger than 15mm, solitary, mostly located in the neck of the gallbladder, and 50% may be accompanied by stones.
Treatment
Surgery
Treatment for polyp-type early gallbladder cancer: once suspected, radical cholecystectomy should be performed instead of traditional cholecystectomy. The loose connective tissues above and below the gallbladder duct should be removed together with the fibrofatty tissues on the liver bed, and chemotherapy and follow-up should be given according to the situation after surgery.
Chemotherapy
Principles of management of proliferative gallbladder disease: Ultrasound examination of the upper abdomen (once every 3 to 6 months) for changes in the condition. Surgery is required when the following conditions are present: lesion diameter greater than 10 mm, broad-based solitary lesion with a tendency to increase in size, age greater than 50 years, gallbladder polyp-like lesion combined with gallbladder stones.