Yeungnam Univ J Med.  2021 Jan;38(1):1-9. 10.12701/yujm.2020.00213.

Gallbladder polyps: evolving approach to the diagnosis and management

• Kim KH

• KMID: 2512060
• DOI: http://doi.org/10.12701/yujm.2020.00213

Abstract

Gallbladder (GB) polyp is a mucosal projection into the GB lumen. With increasing health awareness, GB polyps are frequently found using ultrasonography during health screening. The prevalence of GB polyps ranges between 1.3% and 9.5%. Most patients are asymptomatic and have benign characteristics. Of the nonneoplastic polyps, cholesterol polyps are most common, accounting for 60%–70% of lesions. However, a few polyps have malignant potential. Currently, the guidelines recommend laparoscopic cholecystectomy for polyps larger than 1 cm in diameter due to their malignan potential. The treatment algorithm can be influenced by the size, shape, and numbers of polyps, old age (>50 years), the presence of primary sclerosing cholangitis, and gallstones. This review summarizes the commonly recognized concepts on GB polyps from diagnosis to an algorithm of treatment.

Keyword

Cholecystectomy; Diagnostic imaging; Gallbladder diseases; Gallbladder neoplasms; Polyps

Figure

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  Fig. 1. Ultrasonography shows a polypod lesion (arrow) in the gallbladder. It measured 9.9 mm in maximal diameter and was not mobile regardless of the positional change. Pathologically, it was confirmed as adenoma.

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  Fig. 2. Cholesterol polyp in a 55-year-old woman. (A) Grossly, the gallbladder shows multiple yellowish polyps in the lumen. (B) Microscopically, cholesterol polyps are characterized by cauliflower architecture. Numerous cholesterol-laden macrophages are present (hematoxylin and eosin stain, x100).

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  Fig. 3. Adenomatous gallbladder polyp in a 69-year-old man. (A) Ultrasonography shows a sessile polyp (arrow) with a wide base that was immobile and lacks an acoustic shadow. The polyp measured 16.8 mm in maximal diameter. (B) Microscopically, the adenoma is composed of closely packed, pyloric-type glands lined by mucin-containing cuboidal cells (hematoxylin and eosin stain, x100).

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  Fig. 4. Algorithm for the management of gallbladder polyps. PSC, primary sclerosing cholangitis. a)During follow up, cholecystectomy is advised if the polyp size increases, however, follow up is unnecessary if the polyp disappears.

Reference

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