DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151397

Histopathological patterns of gall bladder diseases with special reference to incidental cases: a hospital based study

Ivy Sharma, Devajit Choudhury

Abstract


Background: Cholecystectomy for gall bladder dieases is the most commonly performed surgical procedure world wide. Routine examination of the gall bladder after surgery throw up interesting possibilities including carcinoma. It is the endeavour of this study to quantify the various outcomes in a tertiary level hospital.

Methods: A total of 348 cases of cholecystectomy specimens were studied to evaluate the histopathological patterns with special reference to incidental asymptomatic gall bladder diseases .The cases were investigated and surgically treated .The specimens were fixed in 10% formalin and sent to the department of Pathology GMCH from department of surgery. The age, sex and other hospital details were recorded from the month of May 2015 to August 2015.The specimens were examined grossly and processed routinely. Sections were stained with haematoxylin and eosin. The gross and microscopic findings examined and noted. The study was aimed at assessing the need for histopathological examination in all cholecystectomy specimens.

Results: In our study out of 348 cases of which 92 cases were female and 256 cases were male. The Male: Female ratio was 1:2.8 in our study. Age distribution showed 10 patients were below 20 years, youngest was 11 years. Between 21-30 there were 80 patients, between 31-40 years 82 patients, between 41-50 years there were 83 patients, between 51-60 years 46 patients and above 60 years 47 patients. Nonneoplastic to neoplastic cases which is 1:115 and percentage of neoplastic cases is 0.86% in our study. Histomorphological variants of the 348 cases in our study showed that maximum cases were of chronic calculous cholecystits(300CASES) followed by chronic cholecystitis with evidence of cholesterosis(14 cases).3 cases of adenocarcinoma were detected out of which 2 cases were incidental adenocarcinoma of gall bladder. Out of the 348 cases studied, 30 cases were diagnosed with incidental gall bladder disease during routine investigation for pregnancy, ureteric colic, dysfunctional uterine bleeding and incisional hernia. Out of this 30 cases 5 patients were male and 25 patients were female (ratio 1:5).

Conclusions: Our study strongly recommends routine histopathological examination of all cholecystectomy specimens for detection of various variants of chronic cholecystits and also of incidental Carcinoma of gall bladder which helps in their treatment and prognosis.

 


Keywords


Chronic calculous cholecystits, Follicular cholecystitis, Xanthogranulomatous cholecystitis, Eosinophilic cholecystitis, Incidental gall bladder disease, Adenocarcinoma of gall bladder

Full Text:

PDF

References


Gallstones and Laparoscopic Cholecystectomy, NIH Consens Statement Online 1992;10(3):1–20. Cited 28 August 2009.

Halldestam I, Enell EL, Kullman E, Borch K. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 2004;91:734–8.

M I M De Zoysa, S K L A De Silva, A Illeperuma; Is Routine Histological Examination of Gallbladder Specimen; Ceylon Medical Journal March 2010;55(1):13-15.

Tantia O, Jain M, Khanna S, Sen B. Incidental Carcinoma Gallbladder During Laparoscopic Cholecystectomy For Symptomatic Gallstone Disease. Surg Endosc. 2009;23:2041-6.

Khanna R, Chansuria R, Kumar M, Shukla HS. Histological changes in gallbladder due to stone disease. Indian J Surg. 2006;68:201-4

Khoo JJ, Misron NA. A Clinicopathological Study Of Nine Cases Of Gallbladder Carcinoma in 1122 cholecystectomies in Johor, Malaysia. Malaysian J Pathol. 2008;30(1):21-6.

Greenberger NJ, Paumgartner G. Chapter 311. Diseases of the Gallbladder and Bile Ducts. In Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J (Eds), 'Harrison’s Principles of Internal Medicine, 18e.Retrieved November 08, 2014.

Friedman LS. Liver, Biliary Tract & Pancreas Disorders. In Papadakis MA, McPhee SJ, Rabow MW. (Eds), 'Current Medical Diagnosis & Treatment 2015. Retrieved November 08, 2014.

Makino I, Yamaguchi T, Sato N, Yasui T, Kita I, Yamaguchi, et al. "Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET"9. World J Gastroenterol. 2009;15(29):3691–3.

RAORV, Kumar A, Sikora SS, Saxena R, Kapoor VK; Kumar; Sikora; Saxena; Kapoor (2005). "Xanthogranulomatous cholecystitis: differentiation from associated gall bladder carcinoma". Trop Gastroenterol. 2005;26(1):31–3.

McCoy JJ, Vila R, Petrossian G, McCall RA, Reddy KS; Vila, et al. Xanthogranulomatous cholecystitis. Report of two cases. J S C Med Assoc. 1976;72(3):78–9.

Albores-Saavedra J, Henson DE. Atlas of Tumor Pathology: Tumors of the Gallbladder and Extrahepatic Bile Ducts. Second Series. Fascicle 22. 2nd ed. Bethesda, MD: Armed Forces Institute of Pathology; 1986. p. 28-123.

Shimizu T, Arima Y, Yokomuro S, Yoshida H, Mamada Y, Nomura T, et al. Incidental gallbladder cancer diagnosed during and after laparoscopic cholecystectomy. J Nippon Med Sch. 2006;73:136–40.

Khan MA, Siddiqui S, Maheshwari V. Advanced presentation of Gallbladder cancer: epidemioclinicopathological study to evaluate the risk factors and assess the outcome. J Pak Med Assoc. 2010;60:217-9.

Sen U, Sankaranarayanan R, Mandal S, Ramanakumar AV, Parkin DM, Siddiqi M. Cancer patterns in eastern India: the first report of the Kolkata cancer registry. Int J Cancer. 2002;100:86–91.

Bhurgri Y, Bhurgri A, Hassan SH, et al. Cancer incidence in Karachi, Pakistan: first results from Karachi Cancer Registry. Int J Cancer. 2000;85:325–9.

Nandakumar A, Gupta PC, Gangadharan P, Visweswara RN, Parkin DM. Geographic pathology revisited: development of an atlas of cancer in India. Int J Cancer. 2005;116:740–54.

Matthyssens LE, Ziol M, Barrat C, Champault GG. Routine surgical pathology in general surgery. Br J Surg. 2006;93:362–8.