Size Of Gallbladder Polyp Research Articles

WP2.4 - Association between Gallbladder Polyp Size and Risk of Malignancy: A single centre retrospective study

Abstract Aims To investigate ultrasound image findings in patients with gallbladder polyps requiring cholecystectomy and assess the risk of gallbladder malignancy associated with polyps. Methods Patients with ultrasound diagnosis of gallbladder polyps who underwent cholecystectomy between January 2019 and September 2023 were included. Histology reports were thoroughly reviewed to find possible diagnosis of gallbladder malignancy. Results A total of 701 patients’ records who had cholecystectomy were reviewed, 45 patients were included as per the inclusion criteria, of whom 73% were women. Mean age was 52±15 years. Average size of the polyps on ultrasound was 7.26mm and approximately 26.7% of polyps were noted to be bigger than 10mm. Overall analysis of the data showed that none of the histology confirmed malignancy. Conclusion Literature review and current ESGAR guidelines suggest that gallbladder polyps, particularly with size >10mm have significant risk of conversion to malignancy. Nearly a quarter of the patients who underwent cholecystectomy for gallbladder polyp had a polyp size >10mm however none of them were proven malignant on histology. This study was conducted on small cohort of patients, further studies on larger cohorts are needed in order to draw conclusions.

Comparison of the Size Measurement of Gallbladder Polyps by Three Different Radiologists in Abdominal Ultrasonography.

There is little information regarding the size measurement differences in gallbladder (GB) polyps performed by different radiologists on abdominal ultrasonography (US). To reveal the differences in GB polyp size measurements performed by different radiologists on abdominal US. From June to September 2022, the maximum diameter of 228 GB polyps was measured twice on abdominal US by one of three radiologists (a third-year radiology resident [reader A], a radiologist with 7 years of experience in abdominal US [reader B], and an abdominal radiologist with 8 years of experience in abdominal US [reader C]). Intra-reader agreements for polyp size measurements were assessed by intraclass correlation coefficient (ICC). A Bland-Altman plot was used to visualize the differences between the first and second size measurements in each reader. Reader A, reader B, and reader C evaluated 65, 77, and 86 polyps, respectively. The mean size of measured 228 GB polyps was 5.0 ± 1.9 mm. Except for the case where reader A showed moderate intra-reader agreement (0.726) for polyps with size ≤ 5 mm, all readers showed an overall high intra-reader reliability (reader A, ICC = 0.859; reader B, ICC = 0.947, reader C, ICC = 0.948), indicative of good and excellent intra-reader agreements. The 95% limit of agreement of reader A, B, and C was 1.9 mm of the mean in all three readers. GB polyp size measurement on abdominal US showed good or excellent intra-reader agreements. However, size changes of approximately less than 1.9 mm should be interpreted carefully because these may be within the measurement error.

Gallbladder polyp size and risk of neoplasia

Introduction: Gallbladder carcinoma is the most common biliary tract carcinoma. A subset develops in polypoidal precursors that are detectable by ultrasound but are not reliably distinguishable from non-neoplastic polyps. Most guidelines recommend cholecystectomy for polyps ≥ 10mm based on a higher rate of neoplasia, however, disagreements exist with management recommendations for smaller incidentally detected polyps. We investigated gallbladder polyps examined at a single institution to determine the relationship between polyp size and a finding of neoplasia. Methods and results: 136 gallbladders (F:M = 2.3:1) with a pre-operative diagnosis and histologically confirmed polyp were identified. 59.6% of polyps were <6 mm and 80.9% <10 mm. 21 (15.4%) of all polyps were neoplastic. Twenty-one point eight percent of polyps ≥6 mm and 30.8% of polyps ≥10 mm were neoplastic. Eighty-eight point nine percent of polyps showing either high grade dysplasia or carcinoma were ≥6 mm (including all carcinomas). Conclusion: Our results are in line with previously published data and reinforce the relationship between polyp size and risk of neoplasia and, more importantly, carcinoma. All polyps ≥10 mm should be well sampled to look for advanced neoplasia.

Longitudinal Ultrasound Assessment of Changes in Size and Number of Incidentally Detected Gallbladder Polyps.

BACKGROUND. Previous European multisociety guidelines recommend routine follow-up imaging of gallbladder polyps (including polyps < 6 mm in patients without risk factors) and cholecystectomy for polyp size changes of 2 mm or more. OBJECTIVE. The purpose of this study was to assess longitudinal changes in the number and size of gallbladder polyps on serial ultrasound examinations. METHODS. This retrospective study included patients who underwent at least one ultrasound examination between January 1, 2010, and December 31, 2020 (as part of a hepatocellular carcinoma screening and surveillance program) that showed a gallbladder polyp. Number of polyps and size of largest polyp were recorded based primarily on review of examination reports. Longitudinal changes on serial examinations were summarized. Pathologic findings from cholecystectomy were reviewed. RESULTS. Among 9683 patients, 759 (8%) had at least one ultrasound examination showing a polyp. Of these, 434 patients (248 men, 186 women; mean age, 50.6 years) had multiple examinations (range, 2-19 examinations; mean, 4.8 examinations per patient; mean interval between first and last examinations, 3.6 ± 3.1 [SD] years; maximum interval, 11.0 years). Among these 434 patients, 257 had one polyp, 40 had two polyps, and 137 had more than two polyps. Polyp size was 6 mm or less in 368 patients, 7-9 mm in 52 patients, and 10 mm or more in 14 patients. Number of polyps increased in 9% of patients, decreased in 14%, both increased and decreased on serial examinations in 22%, and showed no change in 55%. Polyp size increased in 10% of patients, decreased in 16%, both increased and decreased on serial examinations in 18%, and showed no change in 56%. In 9% of patients, gallbladder polyps were not detected on follow-up imaging; in 6% of patients, gallbladder polyps were not detected on a follow-up examination but were then detected on later studies. No gallbladder carcinoma was identified in 19 patients who underwent cholecystectomy. CONCLUSION. Gallbladder polyps fluctuate in size, number, and visibility over serial examinations. Using a 2-mm threshold for growth, 10% increased in size. No carcinoma was identified. CLINICAL IMPACT. European multisociety guidelines that propose surveillance of essentially all polyps and a 2-mm size change as the basis for cholecystectomy are likely too conservative for clinical application.

Development of Cancer in Gall Bladder Polyps Detected on Ultrasound in a High Risk Population

Objectives: Current literature regarding the assessment of changes in gall bladder polyps is minimal in Pakistan, which is known to have one of the highest risk of developing gall bladder carcinoma. The aim of this study is to determine the occurrence of cancer in incidentally detected Gall Bladder (GB) polyps identified by sonography and to propose surveillance guidelines in high risk population for gall bladder cancer. Methods: Radiological data of all “gall bladder polyps” detected on ultrasounds done between January 2001 and February 2015 was taken at a tertiary care institution and it was evaluated to see changes in the size of GB polyps. Pathologic and clinical follow-up was reviewed from the medical record files. Results: GB polyps from 155 patients (Age range, 18–92 years) were included. US follow-up was performed with minimum follow-up duration of 2 years. The polyps ranged in size from 2-19 mm (mean size, 4 mm). Polyp size remained unchanged in 65 (42 %) polyps, decreased in 25 (16 %), increased in 12 (7 %) and resolved in 53 (34%). None of the polyps ranging in size from 1-6 mm turned out to be neoplastic. One polyp of 7 mm showed increase in size and progressed to carcinoma. Conclusion: The risk of malignancy of gall bladder resulting from incidentally detected polyps is very low. Hence, gall bladder polyps measuring upto 6 mm require no additional follow-up. Follow up may be indicated for polyps that are greater than or equal to 7 mm in size. Keywords: Gall bladder cancer, gall bladder polyps, ultrasonography

Analysis of risk factors for gallbladder polyp formation - A retrospective study based on serial ultrasounds.

To evaluate gallbladder polyp (GBP) formation related risk factors based on serial ultrasounds (US). Risk factors related GBP formation were retrospectively investigated among participants, who had US reexamination and interval >180 days in 5 years. After groups were divided based on US, we compared final data and initial data in GBP new incidence group. Then compared the data in GBP new incidence group and GBP(-) group. Overall 20 447 participants were recruited, including 18 243 in GBP (-) group and 2204 in GBP group. The mean diameters of polyps were 0.455 ± 0.198 mm in initial and 0.420 ± 0.180 mm in final examination. GBP new incidence group included 797 participants. Percentage of GBP new incidence participants was higher than GBP resolved (36.16% vs. 11.71%). Participants in middle age were more likely have GBP size increase or new incidence, and participants in old age (≥60 years old) were with GBP size decrease or resolved. In GBP new incidence group, participants in final US showed higher FBG, higher LDL, lower HDL, higher ALT and higher AST than initial US. Compared with GBP (-) group and, same risk factors, in addition with age, were shown in GBP new incidence group, Logistic regression analysis show that higher LDL, lower HDL and higher AST were risk factors for GBP formation. Participants in middle age were more likely to have GBP new incidence. Higher LDL, lower HDL and higher AST were independently risk factors for GBP formation.

Laparoscopic cholecystectomy for gallbladder polyp is significant in the prevention of gallbladder cancer?

Background: Aim is to evaluate the significance of laparoscopic cholecystectomy for gallbladder polyp by analyzing the accidental incidence of gallbladder cancer diagnosed following surgery for gallbladder polyp and occurrence rate of postcholecystectomy syndrome. Methods: We analyzed several clinical factors and pathohistological findings, and occurrence rate of postcholecystectomy syndrome among patients undergoing the laparoscopic cholecystectomy for gallbladder polyp. Results: A total of 292 patients undergoing laparoscopic cholecystectomy for gallbladder polyp was employed. The average age was 39.8±10.2 years (22–69 years). The percentage of male was 40.4% (118 patients) and female was 59.6% (174 patients). The incidence of gallbladder cancer was 6.8% (20 patients) in the pathohistological findings of gallbladder polyp. The reason of surgery for gallbladder polyp was mostly prevention of gallbladder cancer (191 patients, 65.4%), maldigestion (66 patients, 22.6%), pain (24 patients, 8.2%), fever (7 patients, 2.4%) and nausea (4 patients, 1.4%). The percentage of gallbladder polyp with stone was 4.8% (14 patients). Solitary polyp was 33.2% (97 patients) and multiple polyp was 66.8% (195 patients). The size of gallbladder polyp was less than 1 centimeter 75% (219 patients), 1 to 2 centimeter 21.9% (64 patients) and over 2 centimeter 3.1% (9 patients). Two cases confirmed as gallbladder cancer pathohistologically was less than 5 mm (4, 5 mm) . the rate of postcholecystectomy syndrome was 18.8% (55 out of 292 patients). They mainly suffered from pain in the right upper quadrant (13%, 8 patients), maldigestion (17.8%, 52 patients). And their syndrome occurred mostly in 6 months after operation (78.2%, 43 out of 55 patients). Conclusions: The risk factors of gallbladder polyp malignancy were the size of the gallbladder polyp and the age of the patients. We couldn’t exclude the malignancy risk of gallbladder polyp though the size was small and all gallbladder polyp needs to be resected laparoscopically.

Gallbladder polyps - Incidental finding or potential cancer

The term gallbladder polyp (GBP) refers to any elevated lesion on the surface of the gallbladder mucosa. The majority of GBPs are so-called pseudopolyps (cholesterol-polyps, focal adenomyomatosis, hyperplastic polyps or inflammatory polyps) with no malignant potential. True GBPs includes adenomas and adenocarcinomas. Gall bladder adenomas (GBA) are benign; however, they might have a malignant potential as seen in the adenoma-carcinoma sequence in colo-rectal cancer. It is; however, unclear how often adenocarcinomas have arisen from pre-existing adenomas. GBPs are commonly detected as incidental findings on ultrasound (US) of the abdomen or on the histological examination after cholecystectomy. Pseudopolyps are far more likely to be of size 10 mm in size. Patients with polyps of 10 mm or greater should be treated with cholecystectomy. Small GBPs Growth of GBPs Single GBPs are more likely to be malignant than multiple GBPs; and sessile GBPs are significantly more commonly associated with malignancy probably because most gallbladder cancers arise from flat dysplastic epithelium. The diagnostic challenge is to identify the small group of patients with malignant and premalignant GBPs where surgically treatment (cholecystectomy) is indicated, and spare the remaining large group of patients with non-malignant and non-premalignant GBP for unnecessary cholecystectomy and unnecessary follow-up exams. Unnecessary cholecystectomies should be limited to avoid the potential complications related to this procedure. Unnecessary follow-up exams should be limited to reduce the economic cost related hereto; and to reduce the fear that is introduced when a patient is told that “something in the gallbladder has to be controlled”. Unfortunately, the level of evidence regarding guidelines for follow-up and treatment of GBP is low; and randomized controlled trials are lacking. Based upon best practice, I suggest these recommendations: GBP > 10 mm: Surgical treatment (cholecystectomy) is recommended. GBP of 7-9 mm: Follow-up after 12 and 36 months is recommended. If (during the follow-up period) the GBP size increases 2 mm or if the GBP size reaches 10 mm, surgical treatment (cholecystectomy) is recommended. GBP of 6 mm and less: No treatment or follow-up is recommended.

Gallbladder polyps versus cancer: is there a role for prevention? Single centre six-year experience in management of gallbladder polyps

Background: Gallbladder polyps (GBPs) are common, while GB cancer is rare & often presents at late stages (5-year survival 3%). GBPs 1-2cm are associated with 43-77% cancer incidence, while polyps >2cm are almost always 100% malignant. Our aim is to assess management of GBPs in the absence of UK guidelines. Methods: 1743 ultrasound scans (USS) & clinic letters reviewed from Hospital database. Results: 115 patients were diagnosed with GBPs over 6-year period, Jan 2011 - Dec 2016. Male to Female ratio was 48:67 with median age of 55 (24-83). 18 patients had other imaging to confirm diagnosis, where 15 patients had MRI & three had CT. USS showed increased size of GBPs in 52 patients over median period of 12 months (8-60). 7 patients had laparoscopic cholecystectomy and all had evidence of chronic cholecystitis with Rokitansky Aschoff sinuses. 35 patients were discharged from clinic back to their general practitioner(GP). 30 patients are followed up in the Upper GI clinic, 29 with Gastroenterology & 17 had unclear follow-up. Conclusion: USS is the imaging of choice for follow-up. GBPs increasing in size or in cases with discrepancies, we advise follow-up USS to be done by the same sonographer or consultant Radiologist. Annual follow-up USS is advised as no remarkable increase in size occurred in less than 1 year. Patients with GBPs≥8mm should be offered laparoscopic cholecystectomy in the surgical clinic. Elective surgery for GBPs is safe as all patients only had chronic cholecystitis with Rokitansky Aschoff sinuses & no cancer.

Gallbladder polyps versus cancer: is there a role for prevention? Single centre six-year experience in management of gallbladder polyps

Background: Gallbladder polyps (GBPs) are common, while GB cancer is rare & often presents at late stages (5-year survival 3%). GBPs 1-2cm are associated with 43-77% cancer incidence, while polyps >2cm are almost always 100% malignant. Our aim is to assess management of GBPs in the absence of UK guidelines. Methods: 1743 ultrasound scans (USS) & clinic letters reviewed from Hospital database. Results: 115 patients were diagnosed with GBPs over 6-year period, Jan 2011 - Dec 2016. Male to Female ratio was 48:67 with median age of 55 (24–83). 18 patients had other imaging to confirm diagnosis, where 15 patients had MRI & three had CT. USS showed increased size of GBPs in 52 patients over median period of 12 months (8–60). 7 patients had laparoscopic cholecystectomy and all had evidence of chronic cholecystitis with Rokitansky Aschoff sinuses. 35 patients were discharged from clinic back to their general practitioner(GP). 30 patients are followed up in the Upper GI clinic, 29 with Gastroenterology & 17 had unclear follow-up. Conclusion: USS is the imaging of choice for follow-up. GBPs increasing in size or in cases with discrepancies, we advise follow-up USS to be done by the same sonographer or consultant Radiologist. Annual follow-up USS is advised as no remarkable increase in size occurred in less than 1 year. Patients with GBPs≥8mm should be offered laparoscopic cholecystectomy in the surgical clinic. Elective surgery for GBPs is safe as all patients only had chronic cholecystitis with Rokitansky Aschoff sinuses & no cancer.

Does gallbladder polyp size as measured using radiographic modalities predict pathological size in all types of polyps?

Does gallbladder polyp size as measured using radiographic modalities predict pathological size in all types of polyps?

Prevalence and Clinical Characteristics of Gallbladder Polyp in Jeju

Background: Gallbladder polyps are now increasingly detected by ultrasonography. There are many studies reporting theprevalence of gallbladder polyp, however there is no report in Jeju island. The purpose of this study is to research prevalenceand clinical characteristics of gallbladder polyps in adults living in Jeju island.Methods: We have evaluated 3,471 populations who underwent abdominal ultrasonography for health screening examinationat Jeju National University Hospital in Jeju, Korea from January 2011 to June 2012.Results: Prevalence of gallbladder polyp in Jeju island is 10.1%. Prevalence in males is 11.6% and that in females is8.2%(P&lt;0.001). The size of gallbladder polyps mostly are less than 5mm in diameter. 216 subjects (61.5%) have single polypand 135(38.5%) subjects have multiple gallbladder polyps which means 2 or more polyps.Conclusions: The prevalence of gallbladder polyp in Jeju island has found to be higher than the pre-existing reports and theprevalence is higher in males than females. Most polyps are small and single.

Incidentally Detected Gallbladder Polyps: Is Follow-up Necessary?—Long-term Clinical and US Analysis of 346 Patients

To determine the natural history of gallbladder (GB) polyps incidentally detected at ultrasonography (US) and to propose management guidelines for these lesions based on polyp size. The HIPAA-compliant study was approved by the institutional review board, and informed consent was waived. A database search for "polyp" in all US examinations of the GB between January 1, 1999, and December 31, 2001, at a single institution was performed. All subsequent US reports were reviewed to determine changes in GB polyp size. The electronic medical record was searched to obtain clinical and pathologic follow-up. Three hundred forty-six patients (mean age, 51.6 years; range, 20-93 years) with GB polyps were included. There were 156 men (45%) and 190 women (55%). US follow-up (mean, 5.4 years; range, 2-11.5 years) was performed in 149 patients (43%). Polyp size was stable in 90 (60%) polyps, decreased in eight (5%), increased in one (1%), and resolved in 50 (34%). Forty-two patients (12%) underwent cholecystectomy, revealing 13 (31%) GBs with polypoid lesions, 24 (57%) with stones and no polyps, and five (12%) with neither a stone nor a polypoid lesion. Clinical follow-up (mean, 8 years; range, 5-10.4 years) was performed in 155 patients (45%). No patient had clinical evidence of GB-related disease. Overall, no cases of GB malignancy were identified in 346 patients. Mean polyp size was 5.0 mm (range, 1-18 mm). No neoplastic polyps were found at 1-6 mm, one neoplastic polyp was seen at 7-9 mm, and two neoplastic polyps were found at 10 mm or larger. The risk of GB malignancy resulting from incidentally detected polyps is extremely low. Incidentally detected GB polyps measuring 6 mm or less may require no additional follow-up. Data are inconclusive regarding polyps 7 mm or greater, and further studies are warranted.

373 Long-Term Outcome of Gallbladder Polyps in Patients With Primary Sclerosing Cholangitis

Background and Aims: Gallbladder (GB) polyps in PSC patients have a risk of malignancy. Recently, European Association for the study of the liver (EASL) guideline recommends cholecystectomy for GB polyp at any size in patients with PSC without strong evidences of back-up studies. We aimed to evaluate the predictors and long-term outcomes of PSC patients with GB polyps for developing malignancy. Methods: We identified 86 patients with PSC and GB polyp using HICDA codes (05756-21 with 05760-31) and radiological diagnosis codes of GB polyp/mass (760.3104) at the Mayo Clinic, Rochester, MN between January 1, 2000 and August 31, 2009. Twenty-six patients were excluded due to the indefinite diagnosis of PSC or GB polyp (n=22), known cases of cholangiocarcinoma (n=2) and no follow up data (n=2). Clinical information and pathological findings of GB polyps were reviewed. GB polyp was defined by at least two serial reports of radiological diagnosis. The estimated size of small GB polyp was 0.2 cm. Results: Of the 2281 patients with PSC, 60 patients (2.6%) were diagnosed as GB polyp with median age (interquartile range; IQR) of 49.8 years (39.3, 58.6) and 67% of them were male. Median (IQR) Mayo risk score at baseline were 0.33 (-0.11, 1.36). At baseline, 35.7% of patients had GB polyps of at least 2 polyps and 70% of patients had GB polyp with size of less than 0.6 cm. Thirty-one patients (52%) were subsequent received cholecystectomy. Eight of 60 patients (13.3%) develop GB cancer (n=8) while 2 patients had GB dysplasia. No patients without cholecystectomy develop malignant GB lesion during the median (IQR) duration of follow up of 44 (17.5, 84.3) months. By univariate analysis, patients with malignant GB lesions had significantly less frequent number of GB polyp of less than 0.6 cm at first diagnosis and at the last follow up, larger size of GB polyps at first diagnosis and at the last follow up than those with benign GB lesions. By a multivariable logistic analysis, the size of GB polyps at the last follow up was associated with malignant GB lesions (OR= 8.9; 95%CI 2.6-30.3). By using the ROC curve, the GB polyp' size ≥ 1.0 cm had a sensitivity of 99%, specificity of 94%, a negative predictive value of 99% and a positive predictive value of 77%, with an area under the curve of 98% for predicting malignant GB lesion. At the end of follow up, 6 patients (10%) died and 9 patients (15%) received liver transplantation. Conclusions: Thirteen percent of GB polyps in patients with PSC develop GB cancer. The size of GB polyps of at least 1.0 cm at the last follow up was a good predictor for malignant GB lesion.

374 The Risk of Colonic Dysplasia After Liver Transplantation for Primary Sclerosing Cholangitis

Background and Aims: Gallbladder (GB) polyps in PSC patients have a risk of malignancy. Recently, European Association for the study of the liver (EASL) guideline recommends cholecystectomy for GB polyp at any size in patients with PSC without strong evidences of back-up studies. We aimed to evaluate the predictors and long-term outcomes of PSC patients with GB polyps for developing malignancy. Methods: We identified 86 patients with PSC and GB polyp using HICDA codes (05756-21 with 05760-31) and radiological diagnosis codes of GB polyp/mass (760.3104) at the Mayo Clinic, Rochester, MN between January 1, 2000 and August 31, 2009. Twenty-six patients were excluded due to the indefinite diagnosis of PSC or GB polyp (n=22), known cases of cholangiocarcinoma (n=2) and no follow up data (n=2). Clinical information and pathological findings of GB polyps were reviewed. GB polyp was defined by at least two serial reports of radiological diagnosis. The estimated size of small GB polyp was 0.2 cm. Results: Of the 2281 patients with PSC, 60 patients (2.6%) were diagnosed as GB polyp with median age (interquartile range; IQR) of 49.8 years (39.3, 58.6) and 67% of them were male. Median (IQR) Mayo risk score at baseline were 0.33 (-0.11, 1.36). At baseline, 35.7% of patients had GB polyps of at least 2 polyps and 70% of patients had GB polyp with size of less than 0.6 cm. Thirty-one patients (52%) were subsequent received cholecystectomy. Eight of 60 patients (13.3%) develop GB cancer (n=8) while 2 patients had GB dysplasia. No patients without cholecystectomy develop malignant GB lesion during the median (IQR) duration of follow up of 44 (17.5, 84.3) months. By univariate analysis, patients with malignant GB lesions had significantly less frequent number of GB polyp of less than 0.6 cm at first diagnosis and at the last follow up, larger size of GB polyps at first diagnosis and at the last follow up than those with benign GB lesions. By a multivariable logistic analysis, the size of GB polyps at the last follow up was associated with malignant GB lesions (OR= 8.9; 95%CI 2.6-30.3). By using the ROC curve, the GB polyp' size ≥ 1.0 cm had a sensitivity of 99%, specificity of 94%, a negative predictive value of 99% and a positive predictive value of 77%, with an area under the curve of 98% for predicting malignant GB lesion. At the end of follow up, 6 patients (10%) died and 9 patients (15%) received liver transplantation. Conclusions: Thirteen percent of GB polyps in patients with PSC develop GB cancer. The size of GB polyps of at least 1.0 cm at the last follow up was a good predictor for malignant GB lesion.

Long‐term follow up of gallbladder polyps

The management of gallbladder polyps (GBP) is directly linked to the early diagnosis of gallbladder cancer (GBC). This study aimed to evaluate the malignant risk of GBP. In total, 1558 patients diagnosed with GBP were followed. Neoplastic polyps were defined as GBC and its premalignant lesions. The risk for malignancy was estimated with the cumulative detection rate of neoplastic polyps. Thirty-three cases (2.1%) were diagnosed with neoplastic polyps. The cumulative detection rates of neoplastic polyps were 1.7% at 1 year, 2.8% at 5 years, and 4% at 8 years after diagnosis. The size of GBP and the presence of gallstones were risk factors for neoplastic polyps. Polyps > or = 10 mm had a 24.2 times greater risk of malignancy than polyps < 10 mm. However, 15 of 33 neoplastic polyps (45.5%) were < 10 mm at the time of diagnosis of GBP. During follow up in 36 (3.5%) of 1027 cases, an increase in size was detected; of these, nine (25%) had neoplastic polyps. Even small polyps have a risk of malignancy, and careful long-term follow up of GBP will help detect and treat early GBC.

A CASE OF GALLBLADDER CANCER WITH DUBIN-JOHNSON SYNDROME

A 44-year-old man, who had been pointed out having gallstones 10 years before and a polyp of the gallbladder 3 years before, was admitted to the hospital for the purpose of operation because an increase in size of gallbladder polyp (20mm) was noted at an abdominal ultrasonography. The polyp grew segmentally. With a diagnosis of gallbladder cancer, a laparotomy was performed when the liver was black in color. A cholecystectomy was performed and differentiated adenocarcinoma was diagnosed. So a resection of the liver bed and lymph nodes dissection were added, resulting in a radical operation. Postoperative course was uneventful, however, a mild increase in conjugated bilirubin lasted. From re-increase in BSP test and findings of the resected liver, this case was diagnosed as gallbladder cancer associated with Dubin-Johnson syndrome (DJS). This case is very rare in that gallbladder cancer and cholesterol stones were associated with DJS, and that a radical operation was successfully performed and only one case of radical operation has been reported as far as we could review. We present the case together with some bibliographical comments.