Dysplasia in Gallbladder: What Should We Do?

Area of Science:

• Gastroenterology
• Surgical Pathology
• Oncology

Background:

• Incidental gallbladder dysplasia is occasionally found during routine cholecystectomies.
• Further examination is performed to rule out underlying adenocarcinoma when dysplasia is identified.

Purpose of the Study:

• To assess the incidence of invasive adenocarcinoma in additional sections after incidental gallbladder dysplasia detection.
• To evaluate the significance of incidental dysplasia and adenocarcinoma.
• To explore the association between gallbladder dysplasia and synchronous/metachronous biliary tract neoplasia.

Main Methods:

• Retrospective review of 41 cholecystectomy cases (1991-2017) with incidental neoplasia.
• Pathology review to confirm dysplasia grade and adenocarcinoma diagnosis.
• Clinical data obtained from electronic medical records.

Main Results:

• Of 37 dysplasia cases, 10 (27%) had high-grade dysplasia (HGD).
• No gross abnormalities were noted in dysplasia cases, unlike adenocarcinoma cases.
• 18.9% of dysplasia cases were associated with concomitant pancreatobiliary malignancy.
• No subsequent pancreatobiliary neoplasms developed in 16 cases with follow-up.

Conclusions:

• Incidental gallbladder dysplasia without gross abnormalities has a low risk of concurrent invasive carcinoma.
• A significant association (18.9%) with pancreatobiliary malignancy suggests a 'field effect' in the pancreatobiliary tree.
• Serial imaging follow-up may be warranted for patients with gallbladder dysplasia to detect subsequent neoplasia.