Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation

Area of Science:

• Gastroenterology
• Diagnostic Imaging
• Surgical Oncology

Background:

• Gallbladder polyps are frequently detected via ultrasonography, occurring in up to 7% of examinations.
• A broad differential diagnosis exists for polypoid gallbladder masses, encompassing pseudotumors, benign, and malignant neoplasms.
• Distinguishing true polyps from entities like tumefactive sludge is crucial for accurate diagnosis.

Purpose of the Study:

• To review the differential diagnosis of gallbladder polyps.
• To outline imaging findings pertinent to clinical decision-making.
• To provide guidance on the management of gallbladder polyps based on size and risk factors.

Main Methods:

• Review of the literature on gallbladder polyp diagnosis and management.
• Analysis of imaging characteristics and their correlation with clinical outcomes.
• Synthesis of current guidelines for patient stratification and treatment selection.

Main Results:

• Common pseudotumors include cholesterol polyps, adenomyomatosis, and inflammatory polyps.
• Adenomas and primary adenocarcinoma are the most frequent benign and malignant tumors, respectively.
• Polyp size, base, wall thickening, gallstones, patient age, and cancer risk factors influence management decisions.

Conclusions:

• Symptomatic polyps, those over 50 with gallstones, generally warrant cholecystectomy.
• Small, asymptomatic polyps (<5 mm) may not require follow-up.
• Larger polyps (>10 mm) typically undergo excision, with lower thresholds considered for high-risk patients.