GALL BLADDER POLYPS
Dr.Thomas Joseph
GB polyp is the term used to describe any
mucosal projection into the lumen of Gall
bladder
Frequency ranges from 1 to 4%
Neoplastic or non-neoplastic
Non neoplastic lesions account for about
95% of the polyps
Pathology
Cholesterol polyps
Adenomyoma
Inflammatory polyps
Adenomas
Miscellaneous polyps
Cholesterol polyps
Most common type of GB polyps
Variant of cholesterolosis
Typically small (<10mm)
Pedunculated
Usually multiple
Adenomyoma
Adenomyomatosis of the gall bladder
localized to the fundus
Hemispheric bulge into the lumen
Usually single
Adenomas
Neoplastic polyps
Usually single
Can be located anywhere in GB
Multiple in one third
Sometimes innumerable tiny mucosal
polyps-multicentric papillomatosis
Co-exists with stones in half the cases
Two histologic forms-papillary and non
papillary
In papillary form there are branching tree
like skeleton of connective tissue covered
with tall columnar cells
In non papillary form there is a proliferation
of glands encased by fibrous stroma
Adenomas have premalignant potential
Frequency of progression from adenoma
to carcinoma is much lower than that for
colonic polyps
Virtually all adenomas with focus of
carcinoma are more than 12 mm in
diameter
Inflammatory polyps
Solitary in half the cases
Small sessile lesions consisting of
granulation and fibrous tissue infiltrated
with lymphocytes and plasma cells
Miscellaneous Polyps
Fibromas
Leiomyoma
Lipoma
Neurofibroma
Carcinoids
Heterotropic gastric glands
Peutz Jegher’s syndrome
Usually single
Clinical features
Usually asymptomatic
May detach and behave like a stone
Biliary colic
Bile duct obstruction
Pancreatitis
Rarely cause acalculous cholecystitis or
hemobilia
Diagnosis
Usually an incidental finding on USG
Lesion inside the gall bladder without
acoustic shadow
Will not change much with position
Size of more than 10mm predicts the risk
of malignancy
EUS improves diagnostic accuracy
97% accurate in predicting benign nature
Tiny echogenic spots or aggregates of
echogenic spots suggest Cholesterolosis
Multiple microcysts or comet tail artefact
suggest Adenomyomatosis
18 flurodeoxyglucose PET scan – uptake
predicted the presence of malignancy
Colour Doppler
Presence of colour signal
Diffuse and arborizing pattern
Blood flow velocity
Resistive index
CT/CT biliary cystoscopy
Treatment
Patients with biliary colic and USG
showing both stones and polyps should
undergo cholecystectomy
If USG shows only polyps – decision
depends on severity of symptoms and size
of polyps
Asymptomatic polyps less than 10mm can
be followed up by USG
Lesions between 10mm and 18mm should
undergo laproscopic cholecystectomy if
the patient is an acceptable surgical
candidate
If poor surgical risk  follow up by USG or
cholecystography every 6 to 12 months
Lesions more than 18 mm should be
operated
Preferably open cholecystectomy
Thank You