Incidental non-benign gallbladder histopathology after cholecystectomy in an United Kingdom population: Need for routine histological analysis?

Table 1 Summary of histopathological findings

Histology	Subgroup	No (n = 4027)	% Total
Normal		182	4.50%
Cholecystitis		3480	86.3%
Acute		45
Chronic	Gangrenous	3435
	Empyema	29
	Follicular	6
	Xanthogranulomatous	3
		5
Cholesterosis		246	6%
Polypoidal Lesion		44	10%
	Cholesterol-based	42
	Hyperplastic	1
	Adenoma	1
Metaplasia		13	0.3%
Dysplasia		55	1.4%
	Focal LGD*	40
	Multi-Focal LGD	9
	Focal HGD	2
	Multi-focal HGD	4
	(Multi-focal HGD + AC)	(2)
Carcinoma in situ		1	0.02%
Adenocarcinoma		6	0.15%

LGD: Low grade dysplasia; HGD: High grade dysplasia; AC: Adenocarcinoma.

Table 2 Pre- and post-operative characteristics of cases with incidental gallbladder adenocarcinoma

Age	Sex	Pre-operative imaging	Operation details	Operative findings	Tumour type/staging	Further management	Survival (mo)
71	F	USS: Multiple gallstones	Lap	Smooth GB wall with multiple calculi	T1a N0 M0, Adenocarcinoma	No further operation, surveillance CT scans	Alive (64)
68	F	USS: Multiple stones, dilated CBD; CT: Multiple stones, no mass seen	Open	Large GB calculi, no CBD stones on CBD exploration	T2 N0 M0, Adenocarcinoma (MD)	Not fit for further resection (known chronic leukaemia – already on chemotherapy)	Alive (22)
45	F	USS: Stones, thickened GB wall; CT: Inflammatory changes on GB wall	Lap converted to open	Small abscess on GB bed, gross GB wall thickening	T3 N1 M0, Adenocarcinoma (PD)	Revision operation – abandoned as nodules on umbilical port and peritoneum, palliative chemotherapy	12
70	F	USS: Grossly thickened GB wall and multiple gallstones	Lap	Thick dense adhesions with fistulous communication between GB tumour and transverse colon	T3 N1 M1, Adenocarcinoma (PD)	Chemotherapy	12
65	F	USS: Stones, cholecystitis; CT: Marked GB wall thickening, ?cholecystitis	Lap	GB wall inflamed, disintegrated with biliary spillage++	T2 N0 M0, Adenocarcinoma (MD)	Not medically fit for revision surgery; developed nodal disease but not fit for chemo; palliative therapy	37
65	M	USS: Sludge and gallstones (pancreatitis patient)	Lap	Mildly inflamed GB with calculi	T1b N0 M0, Adenocarcinoma (PD)	Revision surgery and lymphadenectomy, chemotherapy	Alive (36)
66	M	USS: Multiple small gallstones	Lap	Smooth GB wall with calculi	Tis N0 M0	No further management	Alive (54)

USS: Ultrasonography; CT: Computed tomography; GB: Gallbladder; MD: Moderately differentiated; PD: Poorly differentiated.