Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient

Özden Öz; Abdullah İnal

doi:10.17343/sdutfd.1615328

Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient

Abstract

Objective: Recognizing epithelial pathologies in the gallbladder and understanding the accompanying clinicopathological features may be useful in determining the decision for cholecystectomy. However, this distinctive selection in gallbladder patients has not been fully elucidated yet. In our series, we aimed to investigate the relationship between epithelial pathologies of the mucosa and clinicopathological findings in cholecystectomy materials and evaluate them in the light of the literature. Materials and Methods: We designed a retrospective cross-sectional study in which we re-evaluated Hematoxylin & Eosin-stained slides of 852 cholecystectomy materials operated in our hospital for two years. Mucosal pathologies were grouped as papillary hyperplasia (PH), pyloric metaplasia (PM), intestinal metaplasia (IM), epithelial dysplasia (ED), and cancer. We obtained the demographic data from the electronic archive system of our hospital. The chi-square test and Fisher’s exact test were used, and p <0.05 was considered significant. Results: The mean age of the patient was 53.17 ± 13.48. PH, PM, IM, PM+IM, ED, and invasive cancer were detected in 11.38%, 8.92%, 11.15%, 07.04%, 3.16%, and 0.47% of all cases, respectively. The mucosal pathologies were mostly observed over 50 years (p <0,05). The mass-forming lesion could not be detected among dysplasia cases (p <0.0001). Conclusions: Age was found to be an essential factor for gallbladder epithelial changes in our study. We argue that taking additional macroscopic samples would be more effective in the definitive diagnosis of gallbladder epithelial pathologies in this age group, and being more careful when deciding on the indication for cholecystectomy in the over-50 age group.

Keywords

Ethical Statement

The Ethics Committee of the University of Izmir Democracy, Buca Seyfi Demirsoy Education and Research Hospital approved using primary tissue samples in this study (Reference Number: 2024/348, Date: December 30, 2024). This study adhered to the principles of the Helsinki Declaration and its subsequent amendments.

References

1. Wang J, Shen S, Wang B, Ni X, Liu H, Ni X, et al. Serum lipid levels are the risk factors of gallbladder stones: A population-based study in China. Lipids Health Dis 2020;19:1–6. https://doi.org/10.1186/s12944-019-1184-3.
2. Song ST, Shi J, Wang XH, Guo Y Bin, Hu PF, Zhu F, et al. Prevalence and risk factors for gallstone disease: A population-based cross-sectional study. J Dig Dis 2020:1–29. https://doi.org/10.1111/1751-2980.12857.
3. Bangash M, Alvi AR, Shahzad N, Shariff AH, Gill RC. Factors associated with premalignant epithelial changes in chronic calculous cholecystitis: A case–control study. World J Surg 2018;42:1701–5. https://doi.org/10.1007/s00268-017-4371-2.
4. Miyazaki M, Takada T, Miyakawa S, Tsukada K, Nagino M, Kondo S, et al. Risk factors for biliary tract and ampullary carcinomas and prophylactic surgery for these factors. J Hepatobiliary Pancreat Surg 2008;15:15–24. https://doi.org/10.1007/s00534-007-1276-8.
5. Adsay V, Saka B, Basturk O, Roa JC. Criteria for pathologic sampling of gallbladder specimens, Am. J. Clin. Pathol 2013;140(2):280, doi: 10.1309/AJCPUJPGQIZ6DC6A.
6. Roa JC, Basturk O, Adsay V. Dysplasia and carcinoma of the gallbladder: Pathological evaluation, sampling, differential diagnosis and clinical implications. Histopathology 2021;79:2–19. https://doi.org/10.1111/his.14360.
7. Nakeeb A, Comuzzie AG, Martin L, Sonnenberg GE, Swartz-Basile D, Kissebah AH, et al. Gallstones: Genetics versus environment. Ann Surg 2002;235:842–9. https://doi.org/10.1097/00000658-200206000-00012.
8. Bastiaenen VP, Corten BJGA, De Savornin Lohman EAJ, De Jonge J, Kraima AC, Swank HA, et al. Safety and cost analysis of selective histopathological examination following appendicectomy and cholecystectomy (FANCY study): Protocol and statistical analysis plan of a prospective observational multicentre study. BMJ Open 2019;9. https://doi.org/10.1136/bmjopen-2019-035912.

9. Esendağli G, Akarca FG, Balci S, Argon A, Şengiz Erhan S, Turhan N, et al. A retrospective evaluation of the epithelial changes/lesions and neoplasms of the Gallbladder in Turkey and a review of the existing sampling methods: A multicentre study. Turk Patoloji Derg 2018;34:41-8. https://doi.org/10.5146/tjpath.2017.01404.
10. Dix FP, Bruce IA, Krypcyzk A, Ravi S. A selective approach to histopathology of the gallbladder is justifiable. Surgeon 2003;1:233–5. https://doi.org/10.1016/S1479-666X(03)80023-9.
11. Sun CD, Zhang BY, Wu LQ, Lee WJ. Laparoscopic cholecystectomy for treatment of unexpected early-stage gallbladder cancer. J Surg Oncol 2005;91:253–7. https://doi.org/10.1002/jso.20318.
12. Swank HA, Mulder IM, Hop WC, Van De Vijver MJ, Lange JF, Bemelman WA. Routine histopathology for carcinoma in cholecystectomy specimens not evidence based: A systematic review. Surg Endosc 2013;27:4439–48. https://doi.org/10.1007/s00464-013-3084-3.
13. Utsumi M, Aoki H, Kunitomo T, Mushiake Y, Yasuhara I, Arata T, et al. Evaluation of surgical treatment for incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy: Single center results. BMC Res Notes 2017;10:1–5. https://doi.org/10.1186/s13104-017-2387-1.
14. Patel K, Dajani K, Iype S, Chatzizacharias NA, Vickramarajah S, Singh P, et al. Incidental non-benign gallbladder histopathology after cholecystectomy in an United Kingdom population: Need for routine histological analysis? World J Gastrointest Surg 2016;8:685. https://doi.org/10.4240/wjgs.v8.i10.685.
15. Wrenn SM, Callas PW, Abu-Jaish W. Histopathological examination of specimen following cholecystectomy: Are we accepting resect and discard? Surg Endosc 2017;31:586–93. https://doi.org/10.1007/s00464-016-5002-y.
16. Talreja V, Ali A, Khawaja R, Rani K, Samnani SS, Farid FN. Surgically resected gall bladder: Is histopathology needed for all? Surg Res Pract 2016;2016:1–4. https://doi.org/10.1155/2016/9319147.
17. Seretis. Metaplastic changes in chronic cholecystitis: Implications for early diagnosis and surgical ıntervention to prevent the gallbladder metaplasia-dysplasia-carcinoma sequence. J Clin Med Res 2013;6:26–9. https://doi.org/10.4021/jocmr1689w.
18. Adsay NV, Basturk O. Dysplasia and early carcinoma of the gallbladder and bile Ducts: Terminology, classification, and significance. Gastroenterol Clin North Am 2024;53:85–108. https://doi.org/10.1016/j.gtc.2023.10.001.
19. Bojan A, Foia L, Vladeanu M, Bojan I, Plesoianu C, Plesoianu A, et al. Understanding the mechanisms of gallbladder lesions: A systematic review. Exp Ther Med 2022;24:1–4. https://doi.org/10.3892/etm.2022.11541.
20. Koshiol J, Bellolio E, Vivallo C, Cook P, Roa JC, McGee EE, et al. Distribution of dysplasia and cancer in the gallbladder: An analysis from a high cancer-risk population. Hum Pathol 2018;82:87–94. https://doi.org/10.1016/j.humpath.2018.07.015.
21. Albores-Saavedra J, Chable-Montero F, Angeles-Albores D, Schwartz A, Klimstra DS, Henson DE. Early gallbladder carcinoma: A clinicopathologic study of 13 cases of intramucosal carcinoma. Am J Clin Pathol 2011;135:637–42. https://doi.org/10.1309/AJCPFRKCFEDLV03Y.
22. Akki AS, Zhang W, Tanaka KE, Chung SM, Liu Q, Panarelli NC. Systematic selective sampling of cholecystectomy specimens ıs adequate to detect incidental gallbladder adenocarcinoma. American Journal of Surgical Pathology 2019;43:1668–73. https://doi.org/10.1097/PAS.0000000000001351.
23. Bonanome, Andrea; Grundy SM. The natural history of silent gallstones. N Engl J Med 1988:1244–8.
24. Rawla P, Sunkara T, Thandra KC, Barsouk A. Epidemiology of gallbladder cancer. Clin Exp Hepatol 2019;5:93–102. https://doi.org/10.5114/ceh.2019.85166.
25. Hsing AW, Bai Y, Andreotti G, Rashid A, Deng J, Chen J, et al. Family history of gallstones and the risk of biliary tract cancer and gallstones: A population-based study in Shanghai, China. Int J Cancer 2007;121:832–8. https://doi.org/10.1002/ijc.22756.
26. Kumar JR, Tewari M, Rai A, Sinha R, Mohapatra SC, Shukla HS. An objective assessment of demography of gallbladder cancer. J Surg Oncol 2006;93:610–4. https://doi.org/10.1002/jso.20526.
27. Scherber PR, Zúniga SE, Glanemann M, Lammert F. Gallensteine – interdisziplinäre Behandlung Klinik: Wie werden Gallensteine 2020.
28. Luisa Mardones M, Frenz P. Changes in gallbladder cancer mortality and hospital discharges due to preventive cholecystectomy in Chile. Rev Med Chil 2019;147:860–9. https://doi.org/10.4067/S0034-98872019000700860.

Details

Primary Language

English

Subjects

Pathology

Journal Section

Research Article

Authors

Özden Öz ^*
0000-0001-5601-1567
Türkiye

Abdullah İnal
0000-0001-9124-6011
Türkiye

Publication Date

June 19, 2025

Submission Date

January 10, 2025

Acceptance Date

June 1, 2025

Published in Issue

Year 2025 Volume: 32 Number: 2

DOI

https://doi.org/10.17343/sdutfd.1615328

IZ

https://izlik.org/JA86BU73ML

Cite

RIS / Bibtex

APA

Öz, Ö., & İnal, A. (2025). Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient. Medical Journal of Süleyman Demirel University, 32(2), 177-183. https://doi.org/10.17343/sdutfd.1615328

AMA

1.Öz Ö, İnal A. Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient. Med J SDU. 2025;32(2):177-183. doi:10.17343/sdutfd.1615328

Chicago

Öz, Özden, and Abdullah İnal. 2025. “Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient”. Medical Journal of Süleyman Demirel University 32 (2): 177-83. https://doi.org/10.17343/sdutfd.1615328.

EndNote

Öz Ö, İnal A (June 1, 2025) Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient. Medical Journal of Süleyman Demirel University 32 2 177–183.

IEEE

[1]Ö. Öz and A. İnal, “Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient”, Med J SDU, vol. 32, no. 2, pp. 177–183, June 2025, doi: 10.17343/sdutfd.1615328.

ISNAD

Öz, Özden - İnal, Abdullah. “Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient”. Medical Journal of Süleyman Demirel University 32/2 (June 1, 2025): 177-183. https://doi.org/10.17343/sdutfd.1615328.

JAMA

1.Öz Ö, İnal A. Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient. Med J SDU. 2025;32:177–183.

MLA

Öz, Özden, and Abdullah İnal. “Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient”. Medical Journal of Süleyman Demirel University, vol. 32, no. 2, June 2025, pp. 177-83, doi:10.17343/sdutfd.1615328.

Vancouver

1.Özden Öz, Abdullah İnal. Assessment of Gallbladder Epithelial Lesions and Clinicopathological High-Risk Patient. Med J SDU. 2025 Jun. 1;32(2):177-83. doi:10.17343/sdutfd.1615328