Cholesterol Polyps Research Articles

Differential diagnosis between gallbladder adenomas and cholesterol polyps on contrast-enhanced harmonic endoscopic ultrasonography

Differential diagnosis between gallbladder (GB) adenomas and cholesterol polyps based on ultrasonography or endoscopic ultrasonography (EUS) is challenging because they have similar echogenicity and morphology. We evaluated the usefulness of contrast-enhanced harmonic EUS (CEH-EUS) for differentiating between GB adenomas and cholesterol polyps. Between June 2010 and December 2011, a total of 87 patients with GB polyps who underwent a CEH-EUS were reviewed retrospectively. Of the 87 patients, 57 had a cholecystectomy. Of these, 34 patients were diagnosed with adenoma, cholesterol polyp, adenocarcinoma, or adenomyomatosis pathology. The remaining 23 patients were not diagnosed with GB polyps because their lesions separated from the GB mucosal layer during pathological sampling. On CEH-EUS, homogeneous and heterogeneous enhancement was shown in 6 and 2 patients with adenoma and in 4 and 8 patients with cholesterol polyps, respectively. Sensitivity and specificity of CEH-EUS for differential diagnosis of GB adenomas from cholesterol polyps based on the enhancement pattern were 75.0 and 66.6 %, respectively. CEH-EUS might be useful for distinguishing GB adenomas and cholesterol polyps based on enhancement patterns. However, an additional technique such as quantitative perfusion analysis is necessary because visual assessment of CEH-EUS images is subjective.

High b-value diffusion-weighted magnetic resonance imaging for gallbladder lesions: differentiation between benignity and malignancy

Recently, the clinical application of diffusion-weighted magnetic resonance imaging (DWI) has been expanding to abdominal organs. However, only a few studies on gallbladder diseases have been published. The aim of this study was to evaluate the usefulness and limitations of high b-value DWI for gallbladder diseases. A total of 153 patients (mean age 60 ± 15 years, 78 males) who had undergone DWI for evaluating gallbladder wall thickening or polypoid lesions were included in this study. Of these 153 patients, 36 had gallbladder cancer and 117 had benign gallbladder diseases (67 chronic cholecystitis, 44 adenomyomatosis, four cholesterol polyp, one gallbladder adenoma, and one xanthogranulomatous cholecystitis). We evaluated the positive signal rate with DWI and the apparent diffusion coefficient (ADC) value of each disease. The positive signal rate with DWI was significantly higher in gallbladder cancer (78 %) than in benign gallbladder diseases (22 %) (p < 0.001). The mean ADC value of gallbladder cancer was (1.83 ± 0.69) × 10(-3) mm(2)/s and that of benign gallbladder diseases was (2.60 ± 0.54) × 10(-3) mm(2)/s (p < 0.001). Benign gallbladder diseases with acute cholecystitis or a history of that had a higher positive signal rate with DWI (p < 0.001) and a lower ADC value (p = 0.018) than those without such conditions. DWI can contribute to the improvement of the diagnostic capability for gallbladder wall thickening or polypoid lesions by compensating for weaknesses of other modalities by its many advantages, although cases with acute cholecystitis or such history sometimes show false-positive on DWI.

Contrast-Enhanced Ultrasonography in the Diagnosis of Gallbladder Disease

The aim of our study was to evaluate the enhancement patterns of gallbladder disease using contrast-enhanced ultrasonography (CE-US) with the contrast agent levovist. The subjects were 42 patients, of whom 25 had gallbladder cancer, 2 had adenoma, 5 had adenomyomatosis, 5 had cholesterol polyps and 5 had debris. We assessed the enhancement patterns of each case using CE-US with levovist and classified these patterns into 6 types: diffuse, scattered, branched, linear, homogeneous and unenhanced. The enhancement of gallbladder cancer revealed various patterns. Only 4 malignant cases showed branched patterns. We speculated that branched patterns in the present study were possibly the characteristic of malignancy. CE-US easily distinguished a small polypoid lesion from debris. Using CE-US, we visualized the shape of the gallbladder cancer lesions and some areas of direct invasion to the liver, as well as metastasis. CE-US is a minimally invasive diagnostic technique that is useful in visualizing not only the shape of the lesion and some areas of the direct invasion to the liver, but also metastasis. The above findings suggest that imaging using a contrast agent could lead to improvements in the diagnosis of gallbladder lesions.

Sa1574 Usefulness of Contrast Enhanced Harmonic-EUS (CEH-EUS) in the Diagnosis of Neoplastic Gallbladder Polyps

GB (gallbladder) polyps larger than 10mm are generally considered to be indications for cholecystectomy because of the risk of cancerous changes. But EUS alone has limitation in differential diagnosis between neoplastic GB polyps and non-neoplastic GB polyps through only current size criteria. In recent years, contrast medium has been used for ultrasonography to evaluate the hemodynamic of region of interest. This study was to evaluate the usefulness of CEH-EUS in differential diagnosis between neoplastic (adenoma, adenocarcinoma) and non-neoplastic GB polyps (cholesterol polyp, adenomyomatosis).

Gallenblasenpolypen

Gallbladder polyps are a common incidental finding in ultrasound. They may be clinically significant, because adenomas have a malignant potential, in contrast to the benign cholesterol polyps occuring more frequently. As non-neoplastic polyps and neoplastic polyps cannot be morphologically discriminated in ultrasound, maximal diameter of a polyp has proven to be the best predictor for malignancy. Cholecystectomy is widely accepted as the treatment of choice for patients with polyps >1 cm. Patients with polyps <1 cm should have a follow-up check for a longer period of time (with the exception of very small polyps).

Clinical and radiologic preoperative predicting factors for GB cholesterol polyp

PurposeTo use the clinical and radiological data to differentiate non-cholesterol versus cholesterol gall bladder (GB) polyps, which can be useful in deciding the treatment of the patient.MethodsOne hundred and eighty-seven patients underwent cholecystectomy for GB polyps of around 10 mm for 10 years, and were divided into two groups, cholesterol polyps (146 patients) and non-cholesterol polyps (41 patients) based on the postoperative pathological findings. Gender, age, body weight, height, body mass index (BMI), symptoms, laboratory findings, size, number of polyps, presence of GB stone and maximum diameter measured by preoperative ultrasonography (USG), computed tomography (CT), and pathological diameter were subjected to comparative analysis.ResultsPatients diagnosed with cholesterol polyps were younger in age and had higher BMI, and the total cholesterol levels and white blood cell levels were higher, but were not statistically significant. It was notable to see that 28.6% of the cholesterol polyps were not found in the preoperative CT yet the percentage of the undetectable rate was significantly lower (8%) in the non-cholesterol polyp group. There was a discrepancy in maximum diameters between the two radiological methods in both groups but the discrepancy was significantly larger in the cholesterol polyp group.ConclusionThe clinical signs that can be helpful to diagnose whether it is a cholesterol polyp or not are younger patients who have high BMI, polyps which are detectable only on the USG and large maximum diameters between the USG and CT. And if the discrepancy of the maximum diameter is lesser than 1mm the polyp may be considered as a non-cholesterol polyp.

Safra kesesi polibi olan hastalarda kolesistektominin hayat kalitesine etkisi

The effect of cholecystectomy on quality of life in patients with gallbladder polyps Objective: To investigate the effect of cholecystectomy procedure on quality of life and the factors associated with patient satisfaction in patients with gallbladder polyps. Material and Methods: Between January 2000 and December 2005, 59 patients diagnosed gallbladder polyps preoperatively and postoperatively, were completed the questionary using Gastrointestinal Quality of Life Index and global patient satisfaction parameters and the datas were analyzed. Results: Our study showed that cholecystectomy procedure for gallbladder polyp statistically increased patient satisfaction and gastrointestinal quality of life scores. Having symptoms, cholesterol polyp as the histological type and laparoscopic surgery were observed as independent influencing factors to the scores. Conclusion: If nonspecific complaints cannot be explained by other reasons in nonspecific patients with high scores, proposing cholecystectomy to this group of patients have been noted. More randomized prospective studies are needed to demonstrate the etiology of healing process of nonspecific complaints.

Learning Curve of Transumbilical Single Incision Laparoscopic Cholecystectomy (SILS): A Preliminary Study of 80 Selected Patients with Benign Gallbladder Diseases

Transumbilical single incision laparoscopic surgery (SILS) is a new laparoscopic procedure in which only one transumbilical incision is made, demonstrated as a scarless procedure. Here we report a single-center preliminary experience of transumbilical single incision laparoscopic cholecystectomy (SILC) in the treatment of benign gallbladder diseases, defining a single surgeon's learning curve. A total of 80 patients underwent SILC successfully by a single experienced laparoscopic surgeon. The operation was performed following the routine LC procedure. Then the perioperative demographics were recorded and the operative time was used to define the learning curve. The study group included 27 male and 53 female patients with gallstones (56 cases), cholesterol polyps (16 cases), an adenomatous polyp (3 cases), adenomyomatosis (1 case), or complex diseases (4 cases), and all consented to undergo SILC. No patient was converted to normal LC or open surgery. There were no perioperative port-related or surgical complications. The average operative time was 46.9 ± 14.6 min. The average postoperative hospital stay was 1.8 ± 1.3 days. The learning curve of the SILC procedures for this series of selected patients confirmed that SILC is a feasible, safe, and effective approach to the treatment of benign gallbladder diseases. For experienced laparoscopic surgeons, SILC is an easy and safe procedure. Patients benefit from milder pain, a lower incidence of port-related complications, better cosmesis, and fast recovery. The SILC procedure may become another option for the treatment of benign gallbladder diseases for selected patients.

Pathologic Evaluation of Gallbladder in Patients Who Underwent Cholecystectomy Hepatic Resection for Hepatocellular Carcinoma

IntroductionThe purpose of this study was to describe the pathologic findings of the gallbladder in patients who underwent simultaneous cholecystectomy and hepatectomy for hepatocellular carcinoma in Taiwan. MethodsThis was a hospital-based retrospective study. The authors analyzed the medical records of all subjects with hepatocellular carcinoma who were initially treated by hepatic resec- tion and cholecystectomy at 1 medical center in Taiwan from 1995 to 2008. Totally, 549 subjects were enrolled in this study. ResultsThere were 428 men (78.0%) and 121 women (22.0%). The mean age was 55.6 ± 13.2 years (range, 15-88 years). Among the 549 subjects with hepatocellular carcinoma, only 1 patient (0.2%) had gallbladder me- tastasis. The prevalence of gallstones was 9.3%; the prevalence of cholesterolosis of the gallbladder was 6.6%; and the prevalence of cholesterol polyp of the gallbladder was 0.9%. ConclusionsThe prevalence of metastasis from hepatocellular carcinoma to the gallblad- der is low. other lesions inside the gallbladder among patients with hepatocellular carcinoma are benign and they do not always require cholecystectomy.

Rare benign pathologies mimicking malignancy: A cautionary tale for Whipple's resections.

Benign pathologies demonstrated after a Whipple’s resection (pancreatoduodenectomy) for pancreatic and peri-ampullary lesions are relatively uncommon. Here we report two cases where a Whipple’s procedure was undertaken for suspected pancreaticobiliary cancer and where the final histology revealed, in each case, a rare benign lesion. The first case confirmed a cholesterol polyp in the distal common bile duct whilst the second case revealed ampullary intramural ectopic gland hyperplasia. Although pre-operative imaging helps in differentiating some benign lesions from malignant lesions, rare benign pathology may still mimic malignant conditions leading to a Whipple’s resection.

Ultrasound diagnosis of gallbladder polyps

The most frequent benign gallbladder polyps are cholesterol polyps. Next in frequency were adenomas, which may have malignant potential. The aim of this study was to assess the possibility of ultrasonography in the diagnosis and differential diagnosis of cholesterol polyps compared to adenomas. Patients were examined during the period from October 2006. to December 2008. In Department of Ultrasound, Clinic for Gastroenterology and Hepatology, Belgrade. The group of 54 patients analyzed consisted of 30 women (56%) and 24 men (44%). Most (59%) had solitary polyps. In 92.6% of patients the size of polyps was below 10 mm. 74% of respondents were over 50 years. Ultrasonography is the method of choice and gold standard in diagnosis of gallbladder polyps. Based on echoic properties cholesterol polyps can not be distinguished from adenomas. Malignant alteration of polyps also could not be detected. Appropriate ultrasonographic characteristics such as size of polyps, appearance of a broad base that sits on the wall, concomitant lithiasis findings and patient age may be indicative for malignancy.

Profile of gallbladder diseases diagnosed at afyon kocatepe university: a retrospective study

Gallbladder is one of the most commonly encountered specimen in a pathology laboratory. A diverse spectrum of diseases affect the biliary system, often presenting with similar clinical signs and symptoms. We aimed to define the profile of gallbladder diseases in our region, and to determine potential correlations between histopathologic features we observed. We reviewed all cholecystectomies processed in Department of Pathology of Afyon Kocatepe University Hospital between January 2000 and March 2008. Gross and histopathologic features of the specimens were reevaluated. Among 1500 patients; 69.9% were women and 30.1% were men. We found out fourteen primary gallbladder carcinomas (0.93%) with adenocarcinomas being the most frequent type (78.57%). The rate of cholelithiasis was found as 89.9%. The most common type of gallstones was mixed cholesterol type gallstones with 67.5% followed by black pigment and brown pigment types as 23.83% and 5.89%, respectively. The association of metaplasia with dysplasia and also gallstones were statistically significant (p < 0.001, p < 0.005). The rate of the gallbladder polyps was 2.6% with the cholesterol polyps being the most common type (56.4%). Gallbladder diseases often present with similar clinical signs and symptoms and a surgical pathologist should be alert especially of precancerous lesions. With our results, we also conclude that elderly women with longstanding gallstone disease should undergo elective surgery even when no symptoms are present.

Indication for surgical treatment of polypoid lesion of gallbladder

This study was to investigate the indication for surgical treatment of polypoid lesion of gallbladder (PLG). Clinical and pathological data from 121 PLG patients undergoing laparoscopic cholecysteotomy were retrospectively analyzed. Asymptomatic or moderate symptomatic PLG was seen in 67. Pathology test-confirmed cholesterol, hyperplasia, and adenomatous polyps were found in 111 (91.7%), 8 (6. 6%), and 2 (1.7%), respectively. Our data suggest that most PLG might be benign and have non-neoplasm nature. Over-operation may be unnecessary, and the indication for surgical procedure should be prudently controlled. Key words: Gallbladder disease; Cholecystectomy, laparoscopic

Comparison of Surgically Resected Polypoid Lesions of the Gallbladder to their Pre-operative Ultrasound Characteristics

BackgroundPolypoid lesions of the gallbladder (PLG) have been a common finding on ultrasound examinations of the abdomen and are more prevalent since our use of equipment incorporating pulse shaping increased bandwidth, and enhanced phase use for image reconstruction began in 1996. Our study correlates the pre-operative ultrasonographic findings of these lesions to the surgically resected specimen with specific regard to identifying neoplastic polyps. MethodsA retrospective review was performed of 130 patients who had a pre-operative ultrasound of the gallbladder and subsequently underwent cholecystectomy between August 1996 and July 2007 at the Mayo Clinic Rochester. ResultsSeventy-nine pseudopolyps (cholesterol polyps, inflammatory polyps, and adenomyomas) and 15 neoplastic polyps were identified on histopathologic analysis. However, 36 patients (27%) did not have a PLG upon histopathologic analysis. Thirty-one polyps had suspicious ultrasonographic characteristics for neoplastic changes. Twenty-nine were ≥10 mm, 12 had vascularity, and one demonstrated invasion. Of these, there were 23 pseudopolyps and six true polyps with neoplastic changes on final pathology (four dysplastic adenomas and two adenocarcinomas). Three asymptomatic polyps ≤10 mm (4%) in maximum diameter based on pre-operative ultrasound imaging (US) had neoplastic changes at pathology (two dysplastic adenomas and one adenocarcinoma). Several statistically significant risk factors were identified that increased the likelihood for malignancy in a PLG: history of primary sclerosing cholangitis (PSC), local invasion, vascularity, and ≥6 mm maximum diameter based on pre-operative US. Of PLGs ≤10 mm, 7.4% were neoplastic. Twenty-five patients were followed up with at least two serial ultrasound examinations. Of these, seven demonstrated polyp growth. None of these specimens demonstrated neoplastic changes. The positive predictive value (PPV) and negative predictive value (NPV) for ultrasound diagnosing neoplastic changes based on current criteria was 28.5% and 93.1%, respectively, with a false negative rate of 5.0%. Expanding the criteria to include cholecystectomy for PLGs ≥ 6 mm changes the positive predictive value and negative predictive value to 18.5% and 100%, respectively, with a false negative rate of 0%. ConclusionHistopathologic analysis of polypoid lesions of the gallbladder continues to be the gold standard to identify malignancy. Ultrasound has been used extensively in the pre-operative management of these lesions, but modern ultrasound techniques are unable to differentiate between benign and malignant PLGs with any certainty. We recommend that strong consideration be given to surgical resection of PLGs ≥ 6 mm based on pre-operative US due to the significant risk of neoplasm. Additionally, PLGs in all patients with PSC, any patient in whom diligent long-term follow-up cannot be completed, and lesions that demonstrate growth, vascularity, invasion, or are symptomatic require cholecystectomy.

Place de l’imagerie dans le diagnostic et le bilan des tumeurs de la vésicule biliaire

Most of gallbladder tumors are benign. Adenoma, cholesterol polyps, or adenomyomatosis are most frequently typical on ultrasonographic images. All symptomatic lesions must be considered as indications for surgery. It may be difficult to identify precancerous or malignant lesion. Polyps over 1cm are indication for preventive cholecystectomy. In case of suspicious polyp or suspicious wall thickening, endoscopic ultrasonography can be helpful to evaluate local tumoral spread and eliminate differential diagnosis. Unfortunately, diagnosis of gallbladder cancer is often late, when surgical resection can't be curative. Computed tomography and magnetic resonance imaging examinations are then useful for local and metastatic staging.

Polypoid lesions of the gallbladder wall

Modern sonography has led to an increased appraisal of the therapeutic consequences in cases of polypoid lesions of the gallbladder wall. In 30 patients it was attempted to differentiate between cholesterol polyps and polypoid lesions suspect for malignancy. Histologic results and data in the literature induce us to recommend cholecystectomy in solitary lesions of more than 5 mm, combined occurrence with gallstones and in patients beyond the 60th year of life.

Polypoide Läsionen der Gallenblase

Ultrasound examination of the gallbladder was performed in a prospective study (from 1985 to 1988) of 14,841 consecutive patients. Polypoid changes were found in 224 (129 men, 95 women; mean age 54 [18-88] years), sonographically classified as cholesterol polyps in 212, as polypoid lesions of uncertain benignity in 12. Mean observation time of 92 patients with cholesterol polyps was 9 (3-48) months. In six the polyp diameter increased by up to 5 mm: only two of them were operated upon and the diagnosis was confirmed in both. A total of 21 patients suspected of having cholesterol polyps were operated upon, the diagnosis confirmed in 17, chronic cholecystitis in two and, in one case each, thickened wall-adherent bile or wall-adherent concrements as cause of the ultrasound changes. Six of the 12 patients with polypoid lesions of uncertain benignity were operated upon: two had an adenoma, one each had tissue heterotopy, malignant melanoma metastasis, gall-bladder carcinoma and adenomyomatosis.

Gallbladder polyps and gallbladder stones

Over a period of 32 years 689 patients with upper abdominal symptoms were examined radiologically at least twice for gall-bladder polyps and stones. All were without evidence of stones initially, but 181 had gall-bladder polyps on first examination. During a mean observation period of 9 1/2 years gall-bladder stones occurred in 18% (pigment stones in about 24%, solitary cholesterol stones in 30% and multiple ones in 46%), regardless of the presence or absence of gall-bladder polyps. There was no evidence for a change from polyps to stones. Cholesterolosis runs through four stages in the course of decades; accumulation of cholesterol esters in subepithelial foam-cell nests is characteristic. 95% of gall-bladder polyps are cholesterol polyps which gradually empty. Prophylactic cholecystectomy for gall-bladder polyps is justified only if they are more than 10 mm in diameter.

Pre-operative predictive factors for gallbladder cholesterol polyps using conventional diagnostic imaging

To determine the clinical data that might be useful for differentiating benign from malignant gallbladder (GB) polyps by comparing radiological methods, including abdominal ultrasonography (US) and computed tomography (CT) scanning, with postoperative pathology findings. Fifty-nine patients underwent laparoscopic cholecystectomy for a GB polyp of around 10 mm. They were divided into two groups, one with cholesterol polyps and the other with non-cholesterol polyps. Clinical features such as gender, age, symptoms, size and number of polyps, the presence of a GB stone, the radiologically measured maximum diameter of the polyp by US and CT scanning, and the measurements of diameter from postoperative pathology were recorded for comparative analysis. Fifteen of the 41 cases with cholesterol polyps (36.6%) were detected with US but not CT scanning, whereas all 18 non-cholesterol polyps were observed using both methods. In the cholesterol polyp group, the maximum measured diameter of the polyp was smaller by CT scan than by US. Consequently, the discrepancy between those two scanning measurements was greater than for the non-cholesterol polyp group. The clinical signs indicative of a cholesterol polyp include: (1) a polyp observed by US but not observable by CT scanning, (2) a smaller diameter on the CT scan compared to US, and (3) a discrepancy in its maximum diameter between US and CT measurements. In addition, US and the CT scan had low accuracy in predicting the polyp diameter compared to that determined by postoperative pathology.

Differential Diagnosis of Gallbladder Diseases With Contrast-Enhanced Harmonic Gray Scale Ultrasonography

We evaluated the usefulness of contrast-enhanced harmonic gray scale ultrasonographic findings for differential diagnosis of gallbladder diseases. We evaluated contrast-enhanced harmonic gray scale ultrasonographic images from 33 patients with 35 polypoid gallbladder disease lesions larger than 10 mm in diameter, consisting of 12 biliary sludge lesions, 8 cholesterol polyps, 1 inflammatory polyp, 2 adenomas, and 12 carcinomas. After a galactosepalmitic acid contrast agent was injected, lesions were scanned by contrast-enhanced harmonic gray scale ultrasonography in 2 phases: early vascular and late vascular. None of the biliary sludge lesions (n = 12) showed either tumor vessels or tumor enhancement. Lesions showing tumor vessels and tumor enhancement on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as cholesterol polyp, inflammatory polyp, adenoma, or carcinoma. Three (38%) of the 8 cholesterol polyps showed dotted-type tumor vessels. Branched-type tumor vessels were observed in 5 (62%) of the 8 cholesterol polyps, the 1 (100%) inflammatory polyp, both (100%) adenomas, and 3 (25%) of the 12 carcinomas. Tortuous-type tumor vessels were observed in 9 (75%) of the 12 carcinomas. Lesions with tumor enhancement and tortuous-type tumor vessels on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as carcinomas, and the sensitivity, specificity, and accuracy of this diagnosis with the current modality were 75% (9/12), 100% (23/23), and 91% (32/35), respectively. Evaluation of tumor vessels on contrast-enhanced harmonic gray scale ultrasonography may be a useful modality for differentiating gallbladder carcinoma from other polypoid gallbladder disease lesions.