Evaluation and Ultrasound Follow-up of Gallbladder Polyps

Gallbladder polyps are growing masses inside the wall of the gallbladder. In the majority of patients, the diagnosis represents an incidental finding of a routine abdominal u l t rasonography, or fo l lowing cholecystectomy for gallstones. The overwhelming majority of these lesions are non-neoplastic therefore called as pseudo-tumor. The widespread use of ultrasonography has made the diagnosis of polypoid lesions of the gallbladder increasingly frequent. Introduction Positive diagnosis of polyps is based on two fundamental semiotic elements: 1. Lack of posterior acoustic shadow; 2. Inability to move when changing the patient's position. Gallbladder polyps have been observed in 0.4 percent of resected gallbladders, and in 1.4 to 4.5 percent of gallbladders assessed by ultrasonography [1]. Over 90 percent of these lesions are non-neoplastic and represent cholesterol-composed polyps [2]. Gallbladder polyps are most frequently identified in patients between 40 and 50 years of age, and are more common in women. No association was observed between the presence of polyps and the patient's age, sex, weight, number of pregnancies, use of exogenous female hormones, or any other risk [3, 4]. Gallbladder polyps have only rarely been described in children. Methods In our study were included 3680 ultrasonography examinations of ambulatory patients examined at the hospital Nr.2 Q.S.U.T “Mother Theresa”. Examinations have resulted from a total of 24 cases with gallbladder polyps (0.621%) with 10 males and 14 females, with a ratio M / F 1/1.4. In five cases of gallbladder polyps have been associated with biliary sludge and in three cases have been associated with calculus gallbladder. In the vast majority of cases are asymptomatic. In some cases they manifest with mild pain in the right upper quadrant, nausea, vomiting, or dyspeptic syndrome and intolerance to fatty foods, also depending on: Polyp localization; Polyp size; Association or not with calculus or biliary sludge. The classification of gallbladder polyps was first proposed in 1970 based upon a review of 180 benign tumors (polypoid lesions can be categorized as benign). Benign lesions have been further subdivided into neoplastic or non-neoplastic: The most common benign non-neoplastic lesions (pseudo-tumors) are cholesterol polyps (which is referred to as "cholesterolosis"), followed by adenomyomas (wh ich i s re fe r red to as "adenomyomatosis"), and inflammatory polyps. Cholesterolosis and adenomyomatosis are mucosal abnormalities of the gallbladder [5, 6]. They have been referred to as "hyperplastic cholecystoses", a term introduced in 1960 to differentiate them from cholecystitis. The most common malignant lesion in the gallbladder i s adenocarc inoma [7 , 8 ] . Ga l lb ladder adenocarcinomas are much more common than gallbladder adenomas, in contrast to the colon where adenomas are much more common than adenocarcinomas. Squamous cell carcinomas, mucinous cyst adenomas, and adeno-acanthomas of the gallbladder are rare. Histo-pathologically gallbladder polyps are subdivided into: Benign polyps, 90 – 95 % of cases: a) Cholesterol polyps; b) Inflammatory polyps and adenomyomatosis; c) Adenoma. Malignant polyps, 5% of cases: