In primary sclerosing cholangitis, gallbladder polyps are frequently malignant

Division of Gastroenterology and Hepatology, Mayo Medical School, Clinic, and Foundation, Rochester, Minnesota 55905, USA.
The American Journal of Gastroenterology (Impact Factor: 10.76). 06/2002; 97(5):1138-42. DOI: 10.1111/j.1572-0241.2002.05677.x
Source: PubMed


The management of gallbladder polyps/masses in patients with primary sclerosing cholangitis (PSC) (i.e., cholecystectomy vs observation) remains problematic. Given the risk of biliary tract cancer in PSC in the face of the benign nature of most gallbladder polyps in the general population, our aim was to determine the prevalence of gallbladder cancer in PSC patients with a gallbladder mass who had undergone cholecystectomy.
The case records of all patients with PSC undergoing a cholecystectomy at the Mayo Clinic between 1977-1999 were reviewed.
Of the 102 patients with PSC who underwent a cholecystectomy, 14 of 102 (13.7%) had a gallbladder mass. In the subset of patients with gallbladder masses, eight of 14 (57%) had adenocarcinomas (seven primary adenocarcinomas and one metastatic cholangiocarcinoma); the other six had benign masses (five adenomas and one cholesterol polyp). In those patients with benign masses, 33% had associated epithelial cell dysplasia; in patients with primary gallbladder cancers, 57% had associated dysplasia. The patients with primary gallbladder adenocarcinoma had a favorable outcome after cholecystectomy, with a 36-month survival of 66%.
In conclusion, gallbladder neoplasms in PSC patients are malignant in approximately 40-60% of the cases. The presence of gallbladder epithelial cell dysplasia suggests a dysplasia-carcinoma sequence in PSC similar to that observed in ulcerative colitis. Consideration should be given to performing a cholecystectomy in PSC patients with gallbladder polyps. If a cholecystectomy is not performed, careful interval follow-up is warranted.

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    • "Therefore, regardless of size, any gallbladder polyps in a patient with primary sclerosing cholangitis should be considered for cholecystectomy.[40] If a cholecystectomy is not performed, careful follow-up is warranted.[41] "
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    ABSTRACT: Gallbladder cancer is a rather uncommon disease, when it gives symptoms it has usually reached an incurable stage. Therefore, every attempt must be made to find the asymptomatic stages and look for premalignant gallbladder polyps. Even if gallbladder cancer is a rare disease, gallbladder polyps are common, only a few polyps develop to cancer. This makes gallbladder polyps another problem: which are the polyps that must be surgically removed, which shall be followed-up, or for how long? The author used the keyword "gallbladder polypsn" in PubMed and reviewed the scientific literatures published from January 2000 to December 2011. The present review article has summarized almost all respects of gallbladder polyp, including the risk factors, clinical diagnosis and management, and comments made from the author, in which clinical treatments are recommended. It is author's purpose that the 11-year-knowledge about gallbladder polyps summarized from all worlds' literatures is enough to know how clinicians will handle the next patient with gallbladder polyp.
    No preview · Article · May 2012 · North American Journal of Medical Sciences
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    • "It would be of value to remark on these markers of cellular dysplasia with regards to GBC, especially since the natural history of GBC is still under consideration, but there is limited preoperative value in these histological factors unless acquired under biopsy. Despite improvements in imaging, post-operative pathology remains the main diagnostic method for GBC [30]. The results of this study are consistent with the literature . "
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    ABSTRACT: Background: Gallbladder cancer (GBC) is a rare disease of the hepatobiliary tract characterized by silent presentation, poor prognosis, and limited therapy. Current imaging modalities, clinical symptoms and laboratory values are of limited value in diagnosis and tumour markers are used as a clinical adjunct. Five year survival is 5% -12% and a majority of patients survive less than 1 year. Early identification, negative nodal status, and extended cholecystectomy improve survival; adjuvant therapy does not appear to play a role. Objective: To evaluate the effects of stage and nodal status of GBC on survival by analyzing clinical and radiological factors leading to preoperative diagnosis and appropriate sub-sequent management. Results: Forty-three patients (31 female, 12 male) had primary GBC. Average age was 69 years. The most common presenting symptom was pain (65%). Fifteen (35%) patients presented with acute cholecystitis; 9 were suspicious for a mass. Ultrasound and computed tomography were the imaging modalities most often used. Pre-operative diagnoses were made in only 7 (16%) patients, whereas 16 (37%) patients were diagnosed intra-operatively and 20 (47%) post-operatively. Adjuvant chemotherapy was offered in 16 (37%) patients. Average survival was 28 months (range 0.5 -238 months), with a 5-year survival of 13% across all stages. Early GBC (stages 1 -2) had a 5-year survival of 43%, and late GBC (stages 3 -4) had no survival at 5 years, with an average survival of 9 months. Positive nodes decreased survival. Conclusion: Our results mirror what has been reported in the literature. Most patients pre-sented with acute cholecystitis, with confounding clinical data, but few were preoperatively diagnosed with GBC. Im-aging was rarely diagnostic. Late stage GBC, as well as node-positive status, had dismal outcomes with low 1-year and 5-year survival rates. Improved preoperative suspicion of early GBC would allow for more intentional curative resec-tions, before nodes become positive.
    Full-text · Article · Jan 2012 · Journal of Cancer Therapy
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    • "Major risk factors for the development of GBC include polypoid lesions and sclerosing cholangitis (PSC). Larger polyps, especially in the setting of PSC (with or without cirrhosis) have a greater than 50% chance of harboring malignancy [3]. Primary sclerosing cholangitis is a chronic progressive disorder of unknown etiology that is characterized by inflammation, fibrosis, and stricturing of medium size and large ducts in the intrahepatic and extraheptic biliary tree [4]. "
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    ABSTRACT: The incidence of gallbladder carcinoma in cirrhotics is unknown. Known risk factors are primary sclerosing cholangitis and polypoid masses. A sixty year old with primary sclerosing cholangitis, cirrhosis, and gallbladder polyps underwent liver transplantation. A polypoid lesion measuring 1.5 x 0.5 cm was found on the fundus of the gallbladder. Histological examination revealed moderately differentiated adenocarcinoma with full thickness penetration of the gallbladder encroaching liver parenchyma. Angiolymphatic invasion was noted. The lymph nodes, the cystic duct and the common duct were free of tumor (T3N0M0). Extensive evaluation did not demonstrate metastasis. No chemotherapy was given. He is currently six years post procedure and free of disease. "Incidentally" discovered stage IIA gallbladder carcinoma may not negatively affect long term survival after liver transplantation.
    Full-text · Article · Feb 2006 · World Journal of Surgical Oncology
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