Incidental carcinoma of gallbladder in north India: is routine histopathology of all cholecystectomy specimens justified?

Abstract

Background: Gallstones can cause varied spectrum of histopathology. Xanthogranulomatous cholecystitis and metaplasia have been shown to have association with carcinoma gallbladder. Incidental carcinoma of the gallbladder is a nightmare for the patient. Routine histopathology of all cholecystectomy specimens is an effective policy for its early diagnosis and management. Methods: It is a retrospective study of histopathology of cholecystectomy specimens related to gallstones disease done at a rural government in north India. All patients with preoperative or intraoperative gross malignancy of gallbladder were excluded from study. Results: In our study, females were predominating over males with a ratio of 6.07:1. The mean of all patients was 44.16±14.64 years. Chronic cholecystitis was most common (69.81%) histopathological entity. Incidental carcinoma was also revealed in 1.9 % of the cases. Metaplasia and xanthogranulomatous cholecystitis was reported in about 6% cases. Mixed stones were most common type reported in 76.79% cases. Multiple stones (72.8%) were more common than single stones. Majority (58%) of the cases in our study were operated by laparoscopic technique. Gallbladder perforation was most common complication noticed in about 4.15% cases. Conclusions: Despite meticulous preoperative investigations and gross specimen examination, incidental carcinoma of gallbladder is a rule rather than exception in significant number of cases. A routine histopathology of specimen should be considered especially in high risk zones of carcinoma gallbladder.

The Spectrum of Gallbladder Histopathology at a Tertiary Hospital in a Developing Country: A Retrospective Study

“…The prevalence of chronic cholecystitis, the most common pathology within our patient population, was noted to be 78.7%. In accordance with this finding, a study concluded the prevalence of chronic cholecystitis to be 79.8%, which bears remarkable semblance to our finding [19]. Chronic cholecystitis is characterised by marked thickening of the GB wall with associated calcifications, eventually culminating in a pathology termed the porcelain GB.…”

“…In our study, cholesterolosis was observed in 32.8% of the cases. A study conducted by Mondal et al concluded the presence of the pathology in merely 2.9% of the patient population, while Sangwan et al reported a prevalence of 9.43% [5,19]. The prevalence of the pathology in our study was therefore noted to be significantly higher.…”

“…A delayed diagnosis of XGC mandates the need for an extraneous radical surgery rather than the standard cholecystectomy [21]. Moreover, its association with GBC has also been well established [19,21].…”

Selective or Routine Histology of Cholecystectomy Specimens for Diagnosing Incidental Carcinoma of Gallbladder and Correlation with Careful Intraoperative Macroscopic Examination? A Systematic Review

“…The studies that recommend routine histology following cholecystectomy state that a large number of IGBC detected are missed by the surgeons as suspicious gallbladders and are later diagnosed as a histological surprise (Jeelani et al, 2019;Jha et al, 2018;Lundgren et al, 2018;Patel et al, 2016;Sangwan et al, 2015;V et al, 2013;Ghimire et al, 2011;Haq et al, 2011;Shrestha et al, 2010;Khan et al, 2007;Samad, 2005). Routine recommending studies highlight the grave consequences of missing many GBC by not doing routine histological evaluation especially in areas with a high incidence of gall bladder cancer and also because of the bad prognosis associated with the disease (Jeelani et al, 2019;Jha et al, 2018;Patel et al, 2016;Siddiqui et al, 2013).…”

Morphological Spectrum of Gall Bladder Diseases at A Tertiary Care Hospital of Karachi

“…One of the most common diseases among gastrointestinal disorders are those arising from gall bladder. The disease entity varies from cholecystitis (acute, chronic, follicular and xanthogranulomatous), cholelithiasis, cholesterolosis, adenomatous hyperplasia, metaplasia and carcinoma 1 . According to recent epidemiologic study, there is evidence of strong association of Helicobacter pylori species with chronic cholecystitis, gall bladder carcinoma and cholesterol stones.…”