Polypoid lesions of the gallbladder are a general term for all non-stone lesions in which the wall of the gallbladder grows into the lumen in the form of polyps. In China, with the widespread use of ultrasound technology, the detection rate of gallbladder polyp-like lesions is getting higher and higher, and their clinical and pathological characteristics and surgical timing have been widely studied.
1.Clinical features.
The symptoms of most gallbladder polyps are similar to those of chronic cholecystitis, mainly manifesting as mild discomfort in the right upper abdomen and biliary colic when accompanied by stones, but a significant number of patients are asymptomatic and are only detected when doing health checkups. It is generally believed that gallbladder polyp is a predisposing factor for gallbladder cancer. In recent years, there are many reports about gallbladder polyp cancer at home and abroad, especially when accompanied by stones, the chance of cancer is significantly increased.
Gallbladder polyps, also known as gallbladder augmentation lesions or gallbladder tumors, can be divided into true tumors and pseudotumors when analyzed in the sense of gallbladder tumors. The so-called true tumor refers to the gallbladder polyp caused by the hyperplasia of the gland and muscle layer of the gallbladder itself, which is a kind of gallbladder tumor in the real sense. The so-called pseudotumor refers to cholesterol accumulation and crystallization caused by dysfunction and disorder of liver and gallbladder cleaning, inflammatory hyperplasia caused by chronic inflammation of gallbladder, and other proliferative lesions caused by abnormal changes of gallbladder and bile.
2.Pathological characteristics.
From the pathological point of view, they include adenomatous polyps (tubular adenoma, papillary adenoma, mixed polyps), cholesterol polyps, hyperplastic and inflammatory polyps, and adenomyosis of the gallbladder. According to the results of our examination, the
The pathological features are.
①Cholesterol polyp: the tip is composed of vascular connective tissue, with a small amount of mucosal epithelium on the surface and a large number of foam-like cells inside.
② inflammatory proliferative polyp: it is a kind of local tissue hyperplasia with epithelial cells covering the surface and hyperplastic glands in the middle, surrounded by lymphocytic infiltration.
③Gallbladder adenomyosis: refers to fibrous thickening of the gallbladder wall, often infiltrated by lymphocytes and plasma cells, with hyperplasia and hypertrophy of smooth muscle cells, and thickening of the wall of the confined body.
④ Adenomatous polyps: a large amount of glandular tissue. Papillary adenoma is characterized by a dendritic connective tissue core, covered with high columnar epithelial cells, and may have a certain amount of endocrine cells (Seritonin cells), with a certain degree of atypical hyperplasia and carcinoma in situ.
3.Surgical indications.
Regarding the selection of surgical indications for gallbladder polyp-like lesions, namely
(1) solitary, non-tipped polyps;
(2) polyp diameter greater than 1 cm;
(3) Basal width;
(4) symptomatic polyps over 50 years of age;
(5) thickened gallbladder wall;
(6) polyp-like lesions located in the neck of the gallbladder
(7) combined gallbladder stones.
(8) Single lesion, less than 10 mm, asymptomatic, less than 50 years old, allowed for observation and follow-up; lesion enlargement or morphological changes should be treated surgically.
(9) Doppler ultrasound examination of the lesion with abundant blood supply suggests malignant neoplasm.
(10) Polypoid lesions of the gallbladder with obvious symptoms and recurrent recurrence.