In clinical practice, we often encounter patients who come to the clinic very anxiously with an ultrasound exam sheet because a “gallbladder polyp” is found. Most of the patients are nervous, however, there are a few patients who do not think so. Therefore, there is a need for some scientific awareness about gallbladder polyps and the appropriate treatment methods.
Because of the popularity of ultrasound, it is therefore common to find occupying gallbladder lesions clinically, and these occupying lesions, usually diagnosed as gallbladder polyps. In general, gallbladder polyps are divided into two categories: non-neoplastic and neoplastic lesions.
I. Non-neoplastic lesions.
1, cholesterol polyps are the most common (usually not cancerous).
2, inflammatory polyps: a kind of granuloma due to inflammatory stimulation, and generally not cancerous.
3.Adenomatous hyperplasia: it is possible to become cancerous.
4.Adenomyoma (also called adenomyosis): also may become cancerous.
II. Neoplastic lesions.
Among these lesions, benign adenomas are the main ones, while malignant ones are mainly gallbladder cancer.
1. Gallbladder adenoma: Most of them are single tipped polyps with a malignant rate of about 30%, and the larger the tumor is, the higher the chance of cancer. The larger the tumor, the higher the chance of cancer. For adenomas larger than 10mm in diameter, the possibility of cancer is about 90%.
2.Gallbladder adenocarcinoma: It is divided into papillary type, nodular type and infiltrative type. Gallbladder cancer that manifests as polyp-like lesions is often early, among which papillary type is mostly confined to the mucosa and muscle and has good prognosis. If it is infiltrative, it often infiltrates directly into liver tissue and even metastasizes to extensive lymph nodes in the liver, which has a very poor prognosis.
There are 6 risk factors for the development of tumor-prone gallbladder polyp-like lesions.
(1) solitary “polyps”.
(2) Diameter.
(3) wide base or thick tip.
(4) growth of the lesion.
(5) Age >50 years.
(6) Combined gallstones.
Treatment of “gallbladder polyps”
When gallbladder polyps are found clinically, ultrasound and CT or MR are usually recommended for further confirmation. The general principles of treatment are
1, less than 5 mm gallbladder polyps, asymptomatic, usually recommended every 3-6 months ultrasound follow-up, once there are obvious symptoms or polyps rapidly increasing before considering surgery. Usually laparoscopic cholecystectomy is recommended.
2, the diameter of the so-called “gallbladder polyps” greater than 10mm due to the possibility of malignant change, usually recommended surgery to remove.
3, the diameter of polyps <10mm also can not relax the vigilance, must be regular follow-up.
It is worth emphasizing that intraoperative cryopathology must be done for gallbladder occupying lesions, and if the intraoperative pathology suggests malignant tumor, radical surgery for gallbladder cancer should be considered immediately. In our clinic, we often find that patients who are found to have gallbladder-occupying lesions are operated laparoscopically without careful examination in local hospitals, and intraoperative pathology is not performed, and postoperative pathology indicates gallbladder cancer, which, in addition to the possible need for a second operation, may also lead to medical dissemination of tumor.
Therefore, when the examination reveals an occupying gallbladder lesion, the treatment should be carefully chosen.