Surgically Resected Gall Bladder: Is Histopathology Needed for All?

Abstract

Background. Laparoscopic cholecystectomy is considered to be gold standard for symptomatic gall stones. As a routine every specimen is sent for histopathological examination postoperatively. Incidentally finding gall bladder cancers in those specimens is around 0.5–1.1%. The aim of this study is to identify those preoperative and intraoperative factors in patients with incidental gall bladder cancer to reduce unnecessary work load on pathologist and cost of investigation particularly in a developing world. Methods. Retrospective records were analyzed from January 2005 to February 2015 in a surgical unit. Demographic data, preoperative imaging, peroperative findings, macroscopic appearance, and histopathological findings were noted. Gall bladder wall was considered to be thickened if ≥3 mm on preoperative imaging or surgeons comment (on operative findings) and histopathology report. AJCC TNM system was used to stage gall bladder cancer. Results. 973 patients underwent cholecystectomy for symptomatic gallstone disease. Gallbladder carcinoma was incidentally found in 11 cases. Macroscopic abnormalities of the gallbladder were found in all those 11 patients. In patients with a macroscopically normal gallbladder, there were no cases of gallbladder carcinoma. Conclusion. Preoperative and operative findings play a pivotal role in determining incidental chances of gall bladder malignancy.

Routine Histopathological Examination After Cholecystectomy

“…This is in accordance with study conducted by Khan et al 5 shows mean age was 46.22 ± 10.15.In our study shows that most of the patient were female. Female 63(66.3%) and male 32(33.7%).This is in accordance with study conducted by Khan et al, Almuslamani et al, Talreja et al 5,6,7 shows majority were female 73.8%,74.75%,70.29% respectively.…”

Systematic review of management of incidental gallbladder cancer after cholecystectomy

“…However, routine rather than selective histopathological investigation detects more incidental gallbladder cancers. Variation in the use of routine or selective histopathology of the surgical specimen is reported, with arguments supporting either approach. It is important to recognize the risk of a potentially considerable time delay (several weeks) in the diagnosis of cancer, as routine assessment of ‘benign, routine gallbladders’ may not take high priority in most pathology departments.…”

Risk Management of Incidental Gallbladder Cancer in Cholecystectomy Materials

“…Sampling should be done from these areas during macroscopic examination (11). The most common form is infiltrative and the second most common form is a papillary patern (12). In our case of primary gallbladder cancer, the tumor was located in the fundus region also and it showed ulceroinfiltrative development.…”