Polyp of gallbladder (polyp of gallbladder) is a type of lesion in which the wall of the gallbladder bulges into the cystic cavity in a polyp-like fashion. It is also known as polypoid lesion of gallbladder (PLG). Polypoid lesion of gallbladder can be classified as benign or malignant lesions, but non-neoplastic lesions are more common. It is generally believed that almost all polypoid lesions of gallbladder with a diameter of 15 mm or more are malignant neoplastic lesions, so polypoid lesions of gallbladder have been paid more attention in recent years. What is the pathogenesis? The etiology of gallbladder polypoid lesions is still unclear, but it is generally believed that the occurrence of the disease is closely related to chronic inflammation, among which inflammatory polyps and adenomatous hyperplasia are both inflammatory reactive lesions, and cholesterol polyps are the result of systemic lipid metabolism disorders and local inflammatory response of the gallbladder. Pathogenesis PLG is a group of biliary diseases with the same manifestations but containing many different pathological states. The pathology is classified into two categories: non-neoplastic lesions and neoplastic lesions, the latter being subdivided into benign and malignant. 1, non-neoplastic PLG (1) cholesterol polyps: (2) inflammatory polyps: due to chronic inflammatory stimulation, either solitary, or multiple, generally 3-5 mm in size, with thick or inconspicuous tips, similar or slightly reddish in color to the adjacent mucosa, solitary or multiple broad-based nodules. Histology showed focal glandular epithelial hyperplasia with vascular connective tissue mesenchyme and marked inflammatory cell inflammatory polyps, granulomas due to inflammatory stimulation, and marked inflammation of the gallbladder wall surrounding the polyps. No carcinogenesis has been reported, but from the study of carcinogenesis of gallbladder cancer combined with gallstones, it is believed that bacterial chronic cholecystitis may be one of the factors, so the inflammatory polyps cannot be relaxedly observed. (3) Adenomatous hyperplasia and adenomyoma: Adenomatous hyperplasia is a kind of hypertrophic lesion of the gallbladder wall caused by the proliferation of gallbladder epithelium and smooth muscle. ②Segmental type: local thickening of the cystic wall into the lumen to form a “triangular sign”, diffuse centripetal thickening, uneven inner wall, narrowing of the lumen, sometimes accompanied by stones, lipid meal test shows hypercontraction of the gallbladder. (3) Extensive type: Adenomatous hyperplasia and adenomyomatosis are both proliferative lesions that are neither inflammatory nor neoplastic. The former are soft yellow warts, about 5 mm in diameter, solitary or multiple. They consist of abundant connective tissue containing smooth muscle bundles and cupped cells, with surface epithelial hyperplasia and intestinal metaplasia. The latter consists of localized changes in the mucosal epithelium, myofibrillar hyperplasia and limited adenomyomatosis, also known as adenomyomatosis. Both of these lesions may be cancerous. 2.Neoplastic PLG?Among the neoplastic lesions, benign ones are mainly adenoma, while malignant ones are mainly gallbladder cancer. (1) Adenoma: Adenomas are mostly single, tipped polyps. The incidence of adenoma is very low, and although it has the possibility of cancer, it does not pose a clinical threat. (2) Benign mesenchymal tissue tumors: Benign mesenchymal tissue tumors are benign tumors of the gallbladder that originate from supporting tissues. They mainly include fibromas, smooth muscle tumors, and hemangiomas. Symptoms and signs Most patients with CPs have no clinical symptoms and good gallbladder function. Examination methods 1.B ultrasound examination The method is flexible, accurate, non-invasive, repeatable, inexpensive, and easily accepted by many patients, and can accurately show the size, location, number, and cyst wall of polyps. 2.Three-dimensional ultrasound imaging 3.Endoscopic ultrasonography (EUS) 4.CT simulation endoscopy (CTVE) Disease diagnosis 1.Color Doppler ultrasound appears high speed arterial blood flow signal in the mass and within the wall of gallbladder, which is The presence of high speed arterial blood flow signal in the mass and gallbladder wall is an important differentiating feature of primary gallbladder cancer from benign masses and metastatic cancer. The smaller the RI, the more likely it is to be malignant, but it is sometimes insensitive to early-stage gallbladder cancer masses that are too small (<3 mm), and it also has an important relationship with the skill of the operator. Treatment The indications for surgery are controversial. Therefore, most people advocate PLGs ≥10 mm in diameter as an indication for surgery, and caution must be maintained for those <10 mm. Therefore, it is considered that a single lesion >60 years old, with coexisting gallstones and >10 mm should be cholecystectomized even if asymptomatic. The six tumor risk factors of Deng Shaoqing’s comprehensive PLG are: solitary, >10 mm, broad-based or thick tip, growing lesion, age >50 years, and coexisting stones. However, it is also emphasized that vigilance should not be relaxed for <10 mm and regular follow-up is necessary. Complications Polypoid gallbladder cancer accounts for 9%-12% of cases, and about 50% are associated with gallstones Prevention Because the etiology of gallbladder polyp lesions is not clear, it is thought to be related to the chronic inflammatory response to gallbladder inflammation or gallbladder stones. Therefore, the key to the prevention of gallbladder polyps is to actively treat the disease causing chronic inflammation of the gallbladder. Prognosis For those who have obvious symptoms that affect work and life, combined with chronic cholecystitis and stones; polyps with solitary, diameter >10mm, large base or tipped in the neck of gallbladder are indications for cholecystectomy. However, due to the difficulty of preoperative diagnosis, patients often have a fear of cancer, and doctors have the idea of preventing malignant changes, thus there is a tendency to expand the operation.