3/29/2017 Gallbladderpolypsandcholesterolosis

19.3

Gallbladderpolypsandcholesterolosis

Gallbladderpolypsandcholesterolosis Find
Print

TOPICOUTLINE
Gallbladderpolypsandcholesterolosis
INTRODUCTION
Authors SectionEditor DeputyEditor
EPIDEMIOLOGY
WisamFZakko,MD SanjivChopra,MD AnneCTravis,MD,
CLASSIFICATION SalamFZakko,MD, MSc,FACG
CHOLESTEROLOSISAND FACP
CHOLESTEROLPOLYPS
Disclosures
Epidemiologyofcholesterolosis
Pathologyofcholesterolosis
ADENOMYOMATOSIS Lastliteraturereviewversion19.3:FriSep3000:00:00
GMT2011 | Thistopiclastupdated:WedOct2600:00:00
Epidemiologyof
GMT2011 (More)
adenomyomatosis
Pathologyofadenomyomatosis INTRODUCTIONGallbladderpolypsareoutgrowthsofthe
gallbladdermucosalwall.Theyareusuallyfoundincidentallyon
INFLAMMATORYPOLYPS
ultrasonographyoraftercholecystectomy.Whendetectedon
ADENOMAS
ultrasonography,theirclinicalsignificancerelateslargelytotheir
Pathologyofadenomas malignantpotential.Themajorityoftheselesionsarenot
MISCELLANEOUSPOLYPS neoplasticbutarehyperplasticorrepresentlipiddeposits
CLINICALFEATURES (cholesterolosis).Ontheotherhand,imagingstudiesaloneare
RISKOFMALIGNANCY insufficientlyspecifictoexcludethepossibilityofgallbladder
carcinomaorpremalignantadenomas.Furthermore,evenbenign
DIAGNOSIS
lesionscanoccasionallyleadtosymptomssimilartothose
Ultrasonography causedbygallbladderstones.
Oralcholecystography
Computedtomography Whilethewidespreaduseofultrasonographyhasmadethe
Endoscopicultrasonography diagnosisofpolypoidlesionsofthegallbladderincreasingly
Positronemissiontomography frequent,optimalstrategiesforevaluatingtheselesionshavenot
(PET) beenestablished.Thistopicwillreviewtheclinicalsignificance
anddifferentialdiagnosisofgallbladderpolyps,andwillprovidea
MANAGEMENT
practicalapproachtotheirmanagement.Gallbladdercanceris
Polypsalongwithgallstonesor
discussedindetailelsewhere.(See"Gallbladdercancer:
primarysclerosingcholangitis
Epidemiology,riskfactors,clinicalfeatures,anddiagnosis".)
Symptomaticpatients
Asymptomaticpatients EPIDEMIOLOGYGallbladderpolypshavebeenobservedin
Lesionslargerthan18to20 0.004to13.8percentofresectedgallbladders[1],andin1.5to
mm 4.5percentofgallbladdersassessedbyultrasonography[2,3].
Lesionsfrom10to20mm Inonereport,noassociationwasobservedbetweenthe
Lesionsfrom5to10mm presenceofpolypsandthepatient'sage,sex,weight,numberof
Lesionssmallerthan5mm pregnancies,useofexogenousfemalehormones,oranyother
riskfactorsthataregenerallybelievedtobeassociatedwith
SUMMARYAND
RECOMMENDATIONS gallstones[3].Gallbladderpolypshaveonlyrarelybeen
describedinchildren,inwhomtheyoccureitherasaprimary
REFERENCES
disorderorinassociationwithotherdisorders,including
GRAPHICSViewAll metachromaticleukodystrophy,PeutzJegherssyndrome,or
pancreatobiliarymalunion[4].(See"Epidemiologyofandrisk
ALGORITHMS
factorsforgallstones".)
Algorithmgallbladderpolyps
PICTURES CLASSIFICATIONTheclassificationofgallbladderpolypswas
StrawberrygallbladderGross firstproposedin1970baseduponareviewof180benign
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tumors[5].Asageneralrule,polypoidlesionscanbe
19.3
categorizedasbenignormalignant(table1)[6,7].Benign
lesionsarefurthersubdividedintoneoplasticornonneoplastic.

Themostcommonbenignneoplasticlesionisanadenoma.
Gallbladderpolypsandcholesterolosis Find Print
Benignmesodermaltumorssuchasleiomyomasand
lipomasarerare.
TOPICOUTLINE

INTRODUCTION Themostcommonbenignnonneoplasticlesions
EPIDEMIOLOGY (pseudotumors)arecholesterolpolyps(thepresenceof
whichisreferredtoas"cholesterolosis"),followedby
CLASSIFICATION
adenomyomas(thepresenceofwhichisreferredtoas
CHOLESTEROLOSISAND "adenomyomatosis"),andinflammatorypolyps[1,5].
CHOLESTEROLPOLYPS Cholesterolosisandadenomyomatosisaremucosal
Epidemiologyofcholesterolosis abnormalitiesofthegallbladder.Theyhavebeenreferred
Pathologyofcholesterolosis toas"hyperplasticcholecystoses,"atermintroducedin
ADENOMYOMATOSIS 1960todifferentiatethemfrominflammatoryconditions
Epidemiologyof suchasacutecholecystitis,sincetheylackinflammatory
adenomyomatosis featuresbutexhibitfeaturesofhyperplasia[8].
Pathologyofadenomyomatosis
Themostcommonmalignantlesioninthegallbladderis
INFLAMMATORYPOLYPS adenocarcinoma.Gallbladderadenocarcinomasaremuch
ADENOMAS morecommonthangallbladderadenomas,incontrastto
Pathologyofadenomas thecolonwhereadenomasaremuchmorecommonthan
MISCELLANEOUSPOLYPS adenocarcinomas.Squamouscellcarcinomas,mucinous
cystadenomas,andadenoacanthomasofthegallbladder
CLINICALFEATURES
arerare.
RISKOFMALIGNANCY
DIAGNOSIS CHOLESTEROLOSISANDCHOLESTEROL
Ultrasonography POLYPSCholesterolosishasbeenrecognizedsince1857,
Oralcholecystography whenVirchowdescribeditinareportontheroleofthe
Computedtomography gallbladderinfatmetabolism[9].Cholesterolosisischaracterized
Endoscopicultrasonography bytheaccumulationoflipidsinthemucosaofthegallbladder
Positronemissiontomography wall.Itisabenignconditionthatisusuallydiagnosed
(PET) incidentallyduringcholecystectomyoronultrasonography.
However,insomepatientsitcanleadtosymptomsand
MANAGEMENT
complicationssimilartothosecausedbygallstones.
Polypsalongwithgallstonesor
primarysclerosingcholangitis EpidemiologyofcholesterolosisCholesterolosisis
Symptomaticpatients commonitsprevalenceinsurgicalstudiesvariesfrom9to26
Asymptomaticpatients percent[9].Alargeautopsyseriesof1300casesfoundthe
Lesionslargerthan18to20 prevalencetobe12percent[10].Cholesterolosisinassociation
mm withgallstonesisbyfarthemostcommonpathologicfindingin
Lesionsfrom10to20mm thegallbladder[3].Mostsurgicalseriessuggestriskfactorsthat
Lesionsfrom5to10mm aresimilartothoseforgallstoneformation.However,asnoted
Lesionssmallerthan5mm above,anultrasoundstudyshowednoassociationwithanyof
SUMMARYAND theknownriskfactorsforgallstones[3].(See
RECOMMENDATIONS 'Epidemiology'above.)

REFERENCES Similarly,whilegallstonediseaseisknowntobemorecommon
inwomen,anautopsyseriesfoundtheprevalenceof
GRAPHICSViewAll
cholesterolosistobeequalbetweenmenandwomen[10].These
ALGORITHMS contradictoryobservationsmaybeexplainedbytheobservation
Algorithmgallbladderpolyps thatsurgicalseriesgenerallyfocusongallbladdersfrompatients
PICTURES whoweresymptomatic,whichisnotnecessarilythecasein
StrawberrygallbladderGross autopsyorultrasonographicstudies.
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19.3

Gallbladderpolypsandcholesterolosis Find
Print

TOPICOUTLINE PathologyofcholesterolosisCholesterolosisresultsfrom
abnormaldepositsoftriglycerides,cholesterolprecursors,and
INTRODUCTION
cholesterolestersintothegallbladdermucosa.Thelipid
EPIDEMIOLOGY accumulationcreatesyellowdepositsthataregenerallyvisibleto
CLASSIFICATION thenakedeye.Theappearanceoftheyellowdepositsona
CHOLESTEROLOSISAND backgroundofhyperemicmucosaledtothedescriptionofthis
CHOLESTEROLPOLYPS findingasa"strawberrygallbladder"(picture1).
Epidemiologyofcholesterolosis Themainmicroscopicfeatureisthepresenceoffatladen
Pathologyofcholesterolosis macrophageswithinelongatedvilli.Mostofthelipidinthe
ADENOMYOMATOSIS cytoplasmofthemacrophagesisintheformofliquidcrystals,
Epidemiologyof whichleadstobirefringenceunderpolarizedlightandgivesa
adenomyomatosis characteristicfoamyappearanceundermicroscopy(picture2).
Pathologyofadenomyomatosis
Thehyperplasticvillusisfilledanddistendedwiththesecells,
INFLAMMATORYPOLYPS creatingthesmallyellownodulesundertheepithelium.Inabout
ADENOMAS twothirdsofcases,thesenodulesarelessthan1mmin
Pathologyofadenomas diameter,whichgivesthemucosathecoarseandgranular
MISCELLANEOUSPOLYPS appearancethatischaracteristicofthediffuseorplanartypeof
cholesterolosis.Thenodulesintheremainingonethirdofcases
CLINICALFEATURES
thenodulesarelargerandpolypoidinappearance(polypoid
RISKOFMALIGNANCY form)[10].
DIAGNOSIS
Inthepolypoidformthedepositsgiverisetosolitaryormultiple
Ultrasonography
cholesterolpolypsthatareattachedtotheunderlyingmucosa
Oralcholecystography
withafragileepithelialpedicle,thecoreofwhichiscomposedof
Computedtomography
lipidfilledmacrophages.Thesepolypscanbreakoff,leadingto
Endoscopicultrasonography
complicationssimilartothosecausedbysmallgallstones,such
Positronemissiontomography asbiliarypain,pancreatitis,andobstructivejaundice.
(PET)
MANAGEMENT ADENOMYOMATOSISAdenomyomatosisisanabnormalityof
Polypsalongwithgallstonesor thegallbladdercharacterizedbyovergrowthofthemucosa,
primarysclerosingcholangitis thickeningofthemusclewall,andintramuraldiverticula.
Symptomaticpatients Despitethename,thisconditiondoesnotinvolveany
adenomatouschangesinthegallbladderepitheliumandisnota
Asymptomaticpatients
premalignantcondition.Adenomyomatosishasbeendescribedby
Lesionslargerthan18to20
differentnames,includinggallbladderdiverticulosis,cholecystitis
mm
glandularisproliferans,andadenomyomatoushyperplasia.
Lesionsfrom10to20mm
Lesionsfrom5to10mm EpidemiologyofadenomyomatosisAdenomyomatosisof
Lesionssmallerthan5mm thegallbladderislesscommonthancholesterolosisinmost
SUMMARYAND reports[11],withsomeexceptions[12].Inonereport,for
RECOMMENDATIONS example,only103casesofadenomyomatosiswerefoundin
REFERENCES over10,000cholecystectomies(1percent)[11].Thisis
comparedtothemuchhigherprevalenceofcholesterolosis(9to
GRAPHICSViewAll 26percent)[9].Adenomyomatosisismorecommoninwomen.
ALGORITHMS PathologyofadenomyomatosisTheabnormalitycanbe
Algorithmgallbladderpolyps diffuse,segmental(annular),orlocalizedtothefundusofthe
PICTURES gallbladder.
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Diffuseadenomyomatosiscausesthickeningand
19.3 irregularityofthemucosalsurfaceandthemusclecoat
leadingtocysticlikestructuresinthegallbladderwallor
polypoidprojectionsfromthemucosaofthegallbladder.In
Gallbladderpolypsandcholesterolosis theearlyphases,theintramuralextensionofthe Find
Print
epitheliumcreatestubulesandcryptsinthelaminapropria
TOPICOUTLINE thataccumulatemucous.Fluidfilledmucosalpockets
INTRODUCTION eventuallyherniateintothewallofthegallbladderand
throughthemuscularispropria,formingcysticstructures
EPIDEMIOLOGY
thatarevisibleongrossinspectionaspoolsofbileinthe
CLASSIFICATION gallbladderwall(RokitanskyAschoffsinuses).Thepointof
CHOLESTEROLOSISAND herniationmayappearsealedduetohypertrophyofthe
CHOLESTEROLPOLYPS muscularis.
Epidemiologyofcholesterolosis
Inthesegmentaltype,acircumferentialringdividesthe
Pathologyofcholesterolosis
gallbladderintoseparateinterconnectedcompartments.
ADENOMYOMATOSIS
Epidemiologyof Inthelocalizedtype,thecysticstructureformsanodule,
adenomyomatosis usuallyinthefundus,thatprojectsintothelumengiving
Pathologyofadenomyomatosis theappearanceofapolyponultrasonography[1215].
INFLAMMATORYPOLYPS Themusclelayerintheinvolvedareaisusuallythickened
tothreetofivetimesitsusualthickness[13,14].
ADENOMAS
Pathologyofadenomas INFLAMMATORYPOLYPSInflammatorypolypsaretheleast
MISCELLANEOUSPOLYPS commonofthenonneoplasticpolyps.Theyappearaseither
CLINICALFEATURES sessileorpedunculatedonanultrasonographicexaminationand
RISKOFMALIGNANCY arecomposedofgranulationandfibroustissuewithplasmacells
andlymphocytes.Polypsareusually5to10mmindiameter,
DIAGNOSIS
althoughinflammatorypolypslargerthan1cmhavebeen
Ultrasonography
described.Theselargepolypscanbeconfusedwithgallbladder
Oralcholecystography carcinoma[16].
Computedtomography
Endoscopicultrasonography ADENOMASAdenomatouspolypsofthegallbladderare
Positronemissiontomography benignepithelialtumorsthat,unliketheircoloniccounterpart,
(PET) arerare.Althoughthetrueincidenceisunknown,inmostseries
itislessthan0.5percent.Inonestudy,nineadenomatous
MANAGEMENT
polypswereidentifiedamong2145cholecystectomies(0.4
Polypsalongwithgallstonesor
percent)[17].
primarysclerosingcholangitis
Symptomaticpatients PathologyofadenomasAdenomasofthegallbladderare
Asymptomaticpatients benignglandulartumorscomposedofcellsresemblingbiliary
Lesionslargerthan18to20 tractepithelium.Theselesionsareclassifiedintopapillaryand
mm nonpapillarytypesonhistology[5].Aclassificationsimilarto
Lesionsfrom10to20mm thatofintestinalpolypshasbeenproposedinwhichthe
Lesionsfrom5to10mm adenomasaredividedintotubular,papillary,andmixed[18].
Lesionssmallerthan5mm
Thefrequencythatadenomasprogresstoadenocarcinomais
SUMMARYAND unknown.InaseriesfromJapan,18patientswithadenomas
RECOMMENDATIONS wereidentifiedamong1605cholecystectomies.Ofthese,seven
REFERENCES adenomascontainedfociofcarcinoma[19].Similartointestinal
adenomas,theriskofmalignancyisrelatedtothesizeofthe
GRAPHICSViewAll
polyp.IntheJapaneseseries,noneofthepolypslessthan12
ALGORITHMS mmcontainedfociofmalignancy.
Algorithmgallbladderpolyps
Inanotherreviewfrom15Japaneseinstitutions,a6percent
PICTURES
incidenceofcarcinomawasreportedinlesionslessthan1.0cm,
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whiletheincidencewas37.5percentinadenomasthatwere1.0
19.3
to2.0cm[20].Inathirdreportinwhichnineadenomaswere
diagnosedamong2145cholecystectomies,alloftheninepolyps
werelessthan1cmandnoneshowedevidenceformalignant
changes[17].(See"Gallbladdercancer:Epidemiology,risk
Gallbladderpolypsandcholesterolosis Find
Print
factors,clinicalfeatures,anddiagnosis",sectionon'Molecular
TOPICOUTLINE
pathogenesis'.)

INTRODUCTION MISCELLANEOUSPOLYPSOtherbenignneoplasmsofthe
EPIDEMIOLOGY gallbladder,suchasfibromas,lipomas,andleiomyomas,are
extremelyrare.Thenaturalhistoryofthesepolypsisnotwell
CLASSIFICATION
defined,butisprobablysimilartotheircounterpartsinother
CHOLESTEROLOSISAND regionsofthegastrointestinaltract.
CHOLESTEROLPOLYPS
Epidemiologyofcholesterolosis CLINICALFEATURESPolypsofthegallbladderaretypically
Pathologyofcholesterolosis incidentalfindingsdetectedduringradiologicimagingofthe
abdomen.Theirsignificanceisrelatedtotheirpotentialfor
ADENOMYOMATOSIS
malignancy.(See"Gallbladdercancer:Epidemiology,riskfactors,
Epidemiologyof
clinicalfeatures,anddiagnosis".)
adenomyomatosis
Pathologyofadenomyomatosis Regardlessoftheirtypeoretiology,gallbladderpolypscanbe
INFLAMMATORYPOLYPS associatedwithbiliarypain.Proposedmechanismsofpain
includeprolapseofthepolypintoHartmann'spouch,which,ifit
ADENOMAS
occursduringgallbladderejection,canleadtobiliarytypepain
Pathologyofadenomas
thatsubsidesuponspontaneousreduction[21].Anotherpossible
MISCELLANEOUSPOLYPS mechanismisthatadetachedportionofapolyplyingfreeinthe
CLINICALFEATURES gallbladderlumencanobstructthecysticductinmuchthesame
RISKOFMALIGNANCY wayagallstonewould,leadingtobiliarycolicorcholecystitis
[22].Thedetachedportioncanalsoobstructthecommonbile
DIAGNOSIS
duct,leadingtoobstructivejaundice[23]andpancreatitis[24].
Ultrasonography
Oralcholecystography Inareviewof3,797cholecystectomies,55casesofgallbladder
Computedtomography cholesterolosiswithoutcholelithiasiswereidentified.Twenty
Endoscopicultrasonography sevenofthesepatientspresentedwithrecurrentattacksofacute
Positronemissiontomography pancreatitis,whichdisappearedaftercholecystectomy.The
(PET) gallbladdershadfrankcholesterolosiswithapolypoid
MANAGEMENT appearance.Theauthorspostulatedthatdetachedcholesterol
polypstemporarilyimpactatthesphincterofOddi,leadingto
Polypsalongwithgallstonesor
primarysclerosingcholangitis pancreatitis[24].
Symptomaticpatients Inadditiontobiliarypain,cholesterolosisandadenomyomatosis
Asymptomaticpatients havealsobeenassociatedwithchronicdyspepticabdominal
Lesionslargerthan18to20 pain.Inastudyof269patientswhounderwentcholecystectomy
mm andwerefoundtohavecholesterolosis,96percenthad
Lesionsfrom10to20mm abdominalpainthatwasdescribedassevereandinamajority,
Lesionsfrom5to10mm thepainhadpersistedformorethantwoyears.Othersymptoms
Lesionssmallerthan5mm reportedinthesamestudywerenauseaandvomiting(61
SUMMARYAND percent)anddyspepsia(60percent).Mostofthesesymptoms
RECOMMENDATIONS resolvedaftercholecystectomy[25].Inanotherstudy,35of55
patientswithchronicabdominalpainunderwent
REFERENCES
cholecystectomycholesterolosiswasfoundin20patients,19of
GRAPHICSViewAll whomhadimprovementinsymptoms[26].
ALGORITHMS Ithasbeensuggestedthatpolyps,cholesterolosis,and
Algorithmgallbladderpolyps adenomyomatosiscanleadtopoorgallbladderemptyingand
PICTURES compartmentalizationthatmayberesponsiblefordyspeptic
StrawberrygallbladderGross symptoms.However,themechanismofthesesymptomsremains
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unclearsincetheseobservationshavenotbeenconfirmedin
19.3
otherstudiesandtheresultsofsurgeryarevariable.Thus,it
remainsdebatablewhethertheselesionscanleadtochronic
dyspepticpain.
Gallbladderpolypsandcholesterolosis Find
Print

TOPICOUTLINE RISKOFMALIGNANCYThemostusefulpredictivefeature
formalignancyisthesizeofthepolyp.Polypslargerthan2cm
INTRODUCTION
arealmostalwaysmalignantand,inmanycases,thecanceris
EPIDEMIOLOGY advanced.Polyps1to2cminsizeshouldberegardedas
CLASSIFICATION possiblymalignant.Severalpathologicstudiessupportthis,with
CHOLESTEROLOSISAND theincidenceofcarcinomabeing43to77percentinpolyps
CHOLESTEROLPOLYPS largerthan1cm[27]and100percentinpolypslargerthan2
Epidemiologyofcholesterolosis cm[28].(See"Gallbladdercancer:Epidemiology,riskfactors,
clinicalfeatures,anddiagnosis".)
Pathologyofcholesterolosis
ADENOMYOMATOSIS DIAGNOSISAdvancesindiagnosticimaginghaveresultedin
Epidemiologyof improvedsensitivityforthedetectionofgallbladderpolyps.
adenomyomatosis Althoughnoneoftheavailablemodalitiescanreliablypredict
Pathologyofadenomyomatosis polyptype,histology,orthepresenceofmalignancy,a
INFLAMMATORYPOLYPS combinationoffeaturesseenonultrasound,computed
tomographicscan,andendoscopicultrasoundcanprovide
ADENOMAS
valuableinformation.
Pathologyofadenomas
MISCELLANEOUSPOLYPS UltrasonographyPolypsareeasilyidentifiedon
ultrasonographyassingleormultipleechogenicfoci.Theycan
CLINICALFEATURES
beeasilydifferentiatedfromgallstonesbecausetheyarefixed
RISKOFMALIGNANCY anddonotmovewhenthepatientisrolledfromonesideto
DIAGNOSIS another.Inaddition,theydonotcastashadow(picture3).A
Ultrasonography fewsmallstudiessuggestthatcontrastenhancedultrasound,
Oralcholecystography whichusesmicrobubblecontrastagentsinjectedintothe
Computedtomography peripheralcirculationtoimprovevisualization,mayfacilitatethe
Endoscopicultrasonography detectionofpolypsbyhelpingtodistinguishthemfrommural
Positronemissiontomography folds,gallbladdercontents,orsludge[29].
(PET)
SeveralstudieshavedemonstratedthattheuseofDoppler
MANAGEMENT ultrasoundmayalsohelpdifferentiatebenignlesionsfrom
Polypsalongwithgallstonesor primarygallbladdermalignancies.Thesereports,whichwere
primarysclerosingcholangitis mostlyfromJapan,demonstratedthatthepresenceofcolor
Symptomaticpatients signal,thepatternofthesignal,theresistiveindex,and
Asymptomaticpatients particularlyflowvelocityhelptoidentifyprimarymalignancyof
Lesionslargerthan18to20 thegallbladderfrombenignlesions.Inmostofthesestudies,
mm colorDopplerwasmoreusefulthanconventionalabdominal
Lesionsfrom10to20mm ultrasoundindiagnosinggallbladderlesions,mostlydueto
Lesionsfrom5to10mm estimationofarterialflowvelocityhowever,therewasoverlap
Lesionssmallerthan5mm invelocities,anddependingonthecutoffoftheflowvelocity
SUMMARYAND used,itwasnotfullycapableofidentifyingallmalignantlesions,
RECOMMENDATIONS particularlyearlyT1lesions,perhapsrelatedtolowsensitivityin
detectingfinebloodflowintheselesions[3036].
REFERENCES
Ultrasonographycandelineateotherusefuldistinguishing
GRAPHICSViewAll
characteristicsintheappearanceofpolyps,including
ALGORITHMS echogenicity,surfacearchitecture,andthepresenceorabsence
Algorithmgallbladderpolyps ofapedicle.
PICTURES
Thefollowingcharacteristicshavebeennoted:
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Cholesterolpolypsareusuallymultiple,homogeneous,and
19.3 pedunculatedpolypoidlesionsthataremoreechogenic
thantheliverparenchyma(picture4).Theymayormay
notcontainhyperechoicspotsandhaveamulberrylike
Gallbladderpolypsandcholesterolosis surface.Cholesterolpolypsareusuallysmallerthan1cm.
Find
Print

TOPICOUTLINE
Adenomasarehomogeneous,areisoechoicwiththeliver
parenchyma,haveasmoothsurface,anddonothavea
INTRODUCTION pedicle(picture5).
EPIDEMIOLOGY
Adenocarcinomasarehomogeneous,heterogeneous
CLASSIFICATION
sessile,ormasslikepolypoidstructuresthatareusually
CHOLESTEROLOSISAND isoechoicwiththeliverparenchymaandexhibita
CHOLESTEROLPOLYPS
mulberrylikesurface[37].
Epidemiologyofcholesterolosis
Pathologyofcholesterolosis Whenlocatedinthefundus,adenomyomatosiscan
ADENOMYOMATOSIS produceamucosalprojectionthatcangivetheappearance
ofapolyponultrasonography(picture6).Thesepolypoid
Epidemiologyof
adenomyomatosis lesionsareabout10to20mmindiameter[38].
Pathologyofadenomyomatosis
Inareportthatusedthesecriteria,preoperative
INFLAMMATORYPOLYPS ultrasonographycorrectlyidentified89percentofcholesterol
ADENOMAS polyps,81percentofmalignantpolyps,50percentofadenomas,
Pathologyofadenomas and0percentofinflammatorypolyps(table2)[37].
MISCELLANEOUSPOLYPS
Incontrasttocholesterolpolyps,diffusecholesterolosishasno
CLINICALFEATURES specificultrasonographicfinding.Asaresult,thediagnosisis
RISKOFMALIGNANCY usuallymadeduringsurgery.
DIAGNOSIS Inpatientswithadenomyomatosis,ultrasonographyshowsnon
Ultrasonography specificfocalthickening(>4mm)ofthegallbladderwall.Careful
Oralcholecystography examinationmaypredictthepresenceofadenomyomatosisby
Computedtomography revealingdiffuseorsegmentalthickeningwithroundanechoic
Endoscopicultrasonography focithatrepresenttheintramuraldiverticula.
Positronemissiontomography
OralcholecystographyOralcholecystography(OCG)has
(PET)
fallenoutoffavorsinceultrasonographyismuchmoresensitive
MANAGEMENT
andspecific.OCGrequiresafunctioninggallbladderandapatent
Polypsalongwithgallstonesor cysticducttovisualizethegallbladder.Polypsappearas
primarysclerosingcholangitis immobilefillingdefectswhichareusuallydifficulttodifferentiate
Symptomaticpatients fromgallstones.Adenomyomatosishasacharacteristic
Asymptomaticpatients appearanceofaninvaginationinthewallthatmayoccasionally
Lesionslargerthan18to20 showRokitanskyAschoffsinuses(picture7).(See
mm "Uncomplicatedgallstonedisease",sectionon'Oral
Lesionsfrom10to20mm cholecystography'.)
Lesionsfrom5to10mm
ComputedtomographyComputedtomography(CT)ismost
Lesionssmallerthan5mm
usefulinpatientswithgallbladdercancersinceitcanstagethe
SUMMARYAND
diseasebyrevealingliverinvasionormetastasis.(See
RECOMMENDATIONS
"Gallbladdercancer:Epidemiology,riskfactors,clinicalfeatures,
REFERENCES anddiagnosis".)
GRAPHICSViewAll ThereareonlylimiteddataregardingtheuseoftheCTscanin
ALGORITHMS theevaluationofgallbladderpolyps.
Algorithmgallbladderpolyps
Onestudynoted100percentsensitivityofcontrast
PICTURES
enhancedCTfordetectinggallbladderpolypsin20patients
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whosubsequentlyunderwentcholecystectomy[39].Asin
19.3
otherstudies,thesizeofthepolypwasapredictorof
malignancy.Noneofthesixpolypslessthan10mmin
diameterwereneoplastic,while5of14polypsmorethan
10mmindiameterweremalignantandtwowere
Gallbladderpolypsandcholesterolosis Find
Print
adenomas.UnenhancedCTdetectedfouroffive
TOPICOUTLINE
malignanciesandbothadenomas,whereasitmissedall
cholesterolandhyperplasticpolyps.Inaddition,all
INTRODUCTION cholesterolpolypswerepedunculated,whilemostofthe
EPIDEMIOLOGY carcinomasweresessile(table3).Theauthorsconcluded
CLASSIFICATION thatpedunculatedpolypssmallerthan10mmindiameter
CHOLESTEROLOSISAND thatareseenonlyonenhancedCTareverylikelytobe
CHOLESTEROLPOLYPS cholesterolpolyps.
Epidemiologyofcholesterolosis Similarresultswerenotedinamorerecentstudyinvolving
Pathologyofcholesterolosis 59patientswhounderwentultrasoundandCTscanning
ADENOMYOMATOSIS priortolaparoscopiccholecystectomy[40].Inthatstudy,
Epidemiologyof 36percentofcholesterolpolypswereseenbyultrasound
adenomyomatosis andnotbyCT.
Pathologyofadenomyomatosis
INFLAMMATORYPOLYPS AnovelCTtechniquesimilartoCTcolonography("virtual
colonoscopy")hasbeenappliedtothegallbladder.Apilotstudy
ADENOMAS
suggestedthatitwasmoresensitivethanstandardCTandas
Pathologyofadenomas sensitiveasultrasoundfordetectinggallbladderpolyps[41].It
MISCELLANEOUSPOLYPS wasmoreaccuratethanultrasoundincharacterizingthethree
CLINICALFEATURES dimensionalstructureofthepolyps.Aclinicalroleforthis
RISKOFMALIGNANCY techniqueremainstobedefined.

DIAGNOSIS EndoscopicultrasonographyEndoscopicultrasonography
Ultrasonography (EUS)hastheadvantageofimagingthegallbladderthroughthe
Oralcholecystography gastricwallwithoutdeleteriousattenuationbysubcutaneousfat
Computedtomography orinterferencefromintestinalgas,whichmaylimitthe
Endoscopicultrasonography usefulnessofconventionaltransabdominalultrasonography.
Positronemissiontomography ThesebenefitspotentiallymakeEUSamoreaccurateimaging
(PET) modalityforthegallbladdercomparedwithtransabdominal
ultrasonography[4247].However,EUSisnotuniversally
MANAGEMENT
availableandthedataforitsuseinthedifferentialdiagnosisof
Polypsalongwithgallstonesor
gallbladderpolypsaresparse.
primarysclerosingcholangitis
Symptomaticpatients Oneretrospectivestudydefinedcertaincriteriafordiagnosing
Asymptomaticpatients cholesterolpolyps,adenomyomatosis,andadenocarcinomaon
Lesionslargerthan18to20 EUS[42].Thepresenceofinternalechopatternscharacterized
mm astinyechogenicspotsoranaggregationofmultiplehighly
Lesionsfrom10to20mm echogenic1to3mmspotswithorwithoutechopenicareaswas
Lesionsfrom5to10mm considereddiagnosticforcholesterolpolyps.Adenomyomatosis
Lesionssmallerthan5mm (localizedtype)wasdiagnosedwhentherewasasessile
SUMMARYAND echogenicmasscontainingmultiplemicrocysts(correspondingto
RECOMMENDATIONS thedilatedRokitanskyAschoffsinuses)oracomettailartifact.
Intheabsenceofechogenicspots,multiplemicrocysts,ora
REFERENCES
comettailartifact,thelesionwasdiagnosedasneoplastic
GRAPHICSViewAll (adenomaoradenocarcinoma).
ALGORITHMS InafollowupstudybythesamegroupusingthesameEUS
Algorithmgallbladderpolyps criteria,atotalof194patientswithsmall(<20mm)polypoid
PICTURES lesionsunderwentbothtransabdominalultrasonographyand
StrawberrygallbladderGross EUS.Fiftyeightofthesepatientsunderwentsurgeryeither
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19.3
Gallbladderpolypsandcholesterolosis
TOPICOUTLINE
INTRODUCTION
EPIDEMIOLOGY
CLASSIFICATION
CHOLESTEROLOSISAND
CHOLESTEROLPOLYPS
Epidemiologyofcholesterolosis
Pathologyofcholesterolosis
ADENOMYOMATOSIS
Epidemiologyof
adenomyomatosis
Pathologyofadenomyomatosis
INFLAMMATORYPOLYPS
ADENOMAS
Pathologyofadenomas
MISCELLANEOUSPOLYPS
CLINICALFEATURES
RISKOFMALIGNANCY
DIAGNOSIS
Ultrasonography
Oralcholecystography
Computedtomography
Endoscopicultrasonography
Positronemissiontomography
(PET)
MANAGEMENT
Polypsalongwithgallstonesor
primarysclerosingcholangitis
Symptomaticpatients
Asymptomaticpatients
Lesionslargerthan18to20
mm
Lesionsfrom10to20mm
Lesionsfrom5to10mm
Lesionssmallerthan5mm
SUMMARYAND
RECOMMENDATIONS
REFERENCES
GRAPHICSViewAll
ALGORITHMS
Algorithmgallbladderpolyps
PICTURES
StrawberrygallbladderGross
http://cursoenarm.net/UPTODATE/contents/mobipreview.htm?21/37/22096
becauseofsymptomsorasuspicionofaneoplasticlesionon
EUS.Usingthesecriteria,EUScorrectlypredictedthehistology
in97percentofthecasescomparedto76percentfor
transabdominalultrasonography(table4)[43].Inotherreports,
theinvestigatorshavereliedoncontourandinternalecho
Find
Print
patternsfordifferentiatingneoplasticfromnonneoplasticpolyps
[44,45].(See"Gallbladdercancer:Epidemiology,riskfactors,
clinicalfeatures,anddiagnosis".)
Positronemissiontomography(PET)Whengallbladder
cancerissuggestedbyultrasoundfindings,FDGPETcanhelp
establishifthelesionisbenignormalignant.However,itcannot
bereliedupontoexcludemalignancywhenultrasoundishighly
suggestiveofaneoplasticpolyp[48].
MANAGEMENTTheonlyeffectivetreatmentforgallbladder
polypsorcholesterolosisischolecystectomy,whichshouldbe
consideredinsymptomaticpatientsorasprophylaxistoprevent
malignanttransformation.Optimalfollowupofpatientswhodo
notundergocholecystectomyisunclearsincetherehavebeen
fewstudiesandnocontrolledtrialscomparingcholecystectomy
toobservation[49].However,areasonableapproachis
suggestedbelow.
Althoughmostgallbladderpolypsarebenign,themainobjective
istoexcludethepresenceofmalignancybecauseadvanced
gallbladdercancercarriesapoorprognosisandresectionatan
earlystageofferstheonlyhopeforcure.Whatcomplicates
mattersisthatnoneoftheavailableimagingmodalitiescan
unequivocallydistinguishneoplasticfromnonneoplasticpolyps.
Thiscanbeachievedonlybymicroscopicexaminationafter
surgery.Nevertheless,asdiscussedabove,transabdominal
ultrasonographyandendoscopicultrasonographycanprovide
valuableinformationinthedifferentialdiagnosisofgallbladder
polyps.
Polypsalongwithgallstonesorprimarysclerosing
cholangitisPatientswhohavegallbladderpolypsand
concomitantgallstonesshouldundergocholecystectomy
regardlessofthepolypsizeorthepresenceofsymptoms,since
gallstonesareariskfactorforgallbladdercancerinpatientswith
gallbladderpolyps[1,50,51].Gallbladderpolypsarisinginthe
settingofprimarysclerosingcholangitisarefrequentlymalignant
andthusalsowarrantcholecystectomy[52].(See"Clinical
manifestationsanddiagnosisofprimarysclerosingcholangitis".)
SymptomaticpatientsCholecystectomyisrecommendedfor
patientswhohavebiliarycolicorpancreatitis,sincean
appreciableproportionofsuchpatientswithcholesterolosisor
adenomyomatosisimproveaftercholecystectomy[23,25,26].On
theotherhand,patientswithnonspecificdyspepticsymptoms
butwithoutsymptomsconsistentwithbiliarycolicshouldbe
managedconservatively(unlessotherindicationsforpolyp
removalarepresent)sincethepathogenesisofthesesymptoms
isunclearandcholecystectomymaynotrelievethesymptoms.
Suchpatientsshouldbetreatedsymptomatically,asareother
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3/29/2017 Gallbladderpolypsandcholesterolosis

patientswithchronicfunctionaldyspepsia[26].(See"Approach
19.3
tothepatientwithdyspepsia".)

Gallbladderpolypsandcholesterolosis Find
Print

TOPICOUTLINE AsymptomaticpatientsRecommendationsforpatientswho
donotfallintoanyoftheabovecategoriesdependuponthesize
INTRODUCTION
ofthepolyps(algorithm1).
EPIDEMIOLOGY
Lesionslargerthan18to20mmLesionslargerthan
CLASSIFICATION
18to20mmareusuallymalignantandshouldberesected.
CHOLESTEROLOSISAND Becausetheselesionsmayrepresentadvancedcancer,patients
CHOLESTEROLPOLYPS shouldundergopreoperativestagingwithacomputed
Epidemiologyofcholesterolosis tomographic(CT)scanandendoscopicultrasound.Anextended
Pathologyofcholesterolosis cholecystectomywithlymphnodedissectionandpartialhepatic
ADENOMYOMATOSIS resectioninthegallbladderbedisrequiredwhenperforming
Epidemiologyof cholecystectomyformalignancy[37].(See"Gallbladdercancer:
adenomyomatosis Epidemiology,riskfactors,clinicalfeatures,anddiagnosis".)
Pathologyofadenomyomatosis
Lesionsfrom10to20mmPolyps10to20mmin
INFLAMMATORYPOLYPS diametershouldberegardedaspossiblymalignant(incidenceof
ADENOMAS gallbladdercancerof25to77percent).Cancerofthissizeis
Pathologyofadenomas usuallyatanearlystageandlaparoscopiccholecystectomywith
MISCELLANEOUSPOLYPS fullthicknessdissection(removaloftheentireconnectivetissue
layersofthegallbladderbedtoexposetheliversurface)is
CLINICALFEATURES
recommended[37].
RISKOFMALIGNANCY
DIAGNOSIS Lesionsfrom5to10mmLesions5to10mmin
diametermayrepresentcholesterolpolyps,adenomas,or
Ultrasonography
carcinomas.Multiplepolyps,pedunculatedpolyps,andthosethat
Oralcholecystography
arehyperechoiccomparedwiththeliverareusuallycholesterol
Computedtomography
polyps,whilesolitaryandsessilepolypsthatareisoechoicwith
Endoscopicultrasonography
theliveraremorelikelytobeneoplastic(seeabove).
Positronemissiontomography
(PET) Themostreassuringfindingisthestabilityofapolypon
MANAGEMENT repeatedfollowupexaminations,thoughthereisnoconsensus
Polypsalongwithgallstonesor regardingthefrequencyoffollowupultrasounds.Onegroup
primarysclerosingcholangitis recommendsfollowupultrasoundsofpolyps5to10mmin
Symptomaticpatients diameteratthreemonths,sixmonths,andthenyearly[27,53].
Asymptomaticpatients Theneedforfollowupwasdemonstratedinastudyof1027
Lesionslargerthan18to20 patientswithgallbladderpolypswhowerefollowedformorethan
mm oneyear[54].Anincreaseinpolypsizewasnotedin36
Lesionsfrom10to20mm patients(3.5percent),ofwhichnine(0.8percent)were
Lesionsfrom5to10mm neoplastic(definedaseithermalignantorpremalignant).Of
Lesionssmallerthan5mm thoseninepolyps,sixwerelessthan10mminsizepriortothe
SUMMARYAND startoffollowup.
RECOMMENDATIONS
Wesuggestthatpatientsbefollowedyearlyifthepolypisstable
REFERENCES afterthefirsttwoexaminations.Surgeryisindicatedinpatients
withanincreaseinpolypsize.
GRAPHICSViewAll

ALGORITHMS Lesionssmallerthan5mmPolypssmallerthan5mm
Algorithmgallbladderpolyps areusuallybenignandmostfrequentlyrepresent
cholesterolosis.Asymptomaticpatientswithcholesterolpolypsdo
PICTURES
notneedtreatment.However,arepeatultrasoundexamination
StrawberrygallbladderGross HelpimproveUpToDate.DidUpToDateansweryourquestion? Yes No
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3/29/2017 Gallbladderpolypsandcholesterolosis

in6and12monthsmaybeappropriate.Followupexaminations
19.3
arenotnecessaryifthepolypisstable.Medicalmanagement
aimedatincreasingthesolubilityofcholesterolinbileby
administeringursodeoxycholicacidiswithoutbenefitinpatients
withcholesterolosis[55].
Gallbladderpolypsandcholesterolosis Find Print

TOPICOUTLINE SUMMARYANDRECOMMENDATIONS

INTRODUCTION Polypoidlesionsinthegallbladdercanbecategorizedas
EPIDEMIOLOGY benignormalignant(table1).Benignlesionsarefurther
CLASSIFICATION subdividedintoneoplastic(adenomas,leiomyomas,
lipomas)ornonneoplastic(cholesterolpolyps,
CHOLESTEROLOSISAND
CHOLESTEROLPOLYPS adenomyomas,inflammatorypolyps).(See
'Classification'above.)
Epidemiologyofcholesterolosis
Pathologyofcholesterolosis Cholesterolosisresultsfromabnormaldepositsof
ADENOMYOMATOSIS triglycerides,cholesterolprecursors,andcholesterolesters
Epidemiologyof intothegallbladdermucosa.Inabouttwothirdsofcases,
adenomyomatosis thesenodulesarelessthan1mmindiameter.The
Pathologyofadenomyomatosis nodulesintheremainingonethirdofcasesarelargerand
INFLAMMATORYPOLYPS polypoidinappearance(polypoidform).(See
'Cholesterolosisandcholesterolpolyps'above.)
ADENOMAS
Pathologyofadenomas Polypsofthegallbladderaretypicallyincidentalfindings
MISCELLANEOUSPOLYPS detectedduringradiologicimagingoftheabdomen.Their
CLINICALFEATURES significanceisrelatedtotheirpotentialformalignancy.
(See'Clinicalfeatures'above.)
RISKOFMALIGNANCY
DIAGNOSIS Advancesindiagnosticimaginghaveresultedinimproved
Ultrasonography sensitivityforthedetectionofgallbladderpolyps.Although
Oralcholecystography noneoftheavailablemodalitiescanreliablyand
Computedtomography unequivocallypredictthetype,histology,orthepresence
ofmalignancy,acombinationoffeaturesseenon
Endoscopicultrasonography
ultrasound,computedtomography,andendoscopic
Positronemissiontomography
ultrasonographcanprovidevaluableinformation.(See
(PET)
'Diagnosis'above.)
MANAGEMENT
Polypsalongwithgallstonesor Theonlyeffectivetreatmentforgallbladderpolypsor
primarysclerosingcholangitis cholesterolosisischolecystectomy,whichshouldbe
Symptomaticpatients consideredinsymptomaticpatientsorasprophylaxisto
Asymptomaticpatients preventmalignanttransformationinsomesettings.We
Lesionslargerthan18to20 suggestcholecystectomyforpatientswithgallbladder
mm polypswhoalsohavegallstones,primarysclerosing
Lesionsfrom10to20mm cholangitis,biliarycolic,orpancreatitis.Recommendations
Lesionsfrom5to10mm forpatientswhodonotfitintothesecategoriesdepend
Lesionssmallerthan5mm uponthesizeofthepolyps(algorithm1).(See
'Management'above.)
SUMMARYAND
RECOMMENDATIONS
REFERENCES UseofUpToDateissubjecttotheSubscriptionandLicense
Agreement.
GRAPHICSViewAll

ALGORITHMS
REFERENCES
Algorithmgallbladderpolyps
PICTURES
StrawberrygallbladderGross HelpimproveUpToDate.DidUpToDateansweryourquestion? Yes No
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3/29/2017 Gallbladderpolypsandcholesterolosis

1.YangHL,SunYG,WangZ.Polypoidlesionsofthe
19.3 gallbladder:diagnosisandindicationsforsurgery.BrJSurg
199279:227.
2.HeyderN,GnterE,GiedlJ,etal.[Polypoidlesionsofthe
Gallbladderpolypsandcholesterolosis gallbladder].DtschMedWochenschr1990115:243. Find
Print

3.JrgensenT,JensenKH.Polypsinthegallbladder.A
TOPICOUTLINE prevalencestudy.ScandJGastroenterol199025:281.
INTRODUCTION 4.StringerMD,CeylanH,WardK,WyattJI.Gallbladderpolyps
EPIDEMIOLOGY inchildrenclassificationandmanagement.JPediatrSurg
200338:1680.
CLASSIFICATION
5.ChristensenAH,IshakKG.Benigntumorsand
CHOLESTEROLOSISAND
pseudotumorsofthegallbladder.Reportof180cases.Arch
CHOLESTEROLPOLYPS
Pathol197090:423.
Epidemiologyofcholesterolosis
Pathologyofcholesterolosis 6.WeedonD.Benignmucosalpolyps.In:Pathologyofthe
gallbladder,Mason,NewYork1984.p.195.
ADENOMYOMATOSIS
7.LaitioM.Histogenesisofepithelialneoplasmsofhuman
Epidemiologyof
gallbladderII.Classificationofcarcinomaonthebasisof
adenomyomatosis
morphologicalfeatures.PatholResPract1983178:57.
Pathologyofadenomyomatosis
8.JUTRASJA.HyperplasticcholecystosesHickeylecture,
INFLAMMATORYPOLYPS
1960.AmJRoentgenolRadiumTherNuclMed1960
ADENOMAS 83:795.
Pathologyofadenomas
9.SALMENKIVIK.CHOLESTEROSISOFTHEGALLBLADDER.A
MISCELLANEOUSPOLYPS CLINICALSTUDYBASEDON269CHOLECYSTECTOMIES.
CLINICALFEATURES ActaChirScandSuppl1964105:SUPPL324:1.
RISKOFMALIGNANCY 10.FELDMANM,FELDMANMJr.Cholesterosisofthe
DIAGNOSIS gallbladderanautopsystudyof165cases.
Gastroenterology195427:641.
Ultrasonography
Oralcholecystography 11.ShepardVD,WaltersW,DockertyMB.Benignneoplasmsof
Computedtomography thegallbladder.ArchSurg194245:1.
Endoscopicultrasonography 12.JutrasJA,LevesqueHP.Adenomyomaand
Positronemissiontomography adenomyomatosisofthegallbladder,radiologicand
(PET) pathologiccorrelations.RadClinNAmer19664:483.
MANAGEMENT 13.BEANBC,BERENSDL,CULVERGJ.Therelationshipof
Polypsalongwithgallstonesor stenosistoRokitanskyAschoffsinusesofthegallbladder.
primarysclerosingcholangitis AmJRoentgenolRadiumTherNuclMed195777:47.
Symptomaticpatients 14.MaccartyWC.IV.ThePathologyoftheGallbladderand
Asymptomaticpatients someAssociatedLesions:AStudyofSpecimensfrom365
Lesionslargerthan18to20 Cholecystectomies.AnnSurg191051:651.
mm 15.KingES,McCallumP.CholecystitisglandularisProliferans.
Lesionsfrom10to20mm BrJSurg193119:310.
Lesionsfrom5to10mm 16.MaeyamaR,YamaguchiK,NoshiroH,etal.Alarge
Lesionssmallerthan5mm inflammatorypolypofthegallbladdermasqueradingas
SUMMARYAND gallbladdercarcinoma.JGastroenterol199833:770.
RECOMMENDATIONS 17.FarinonAM,PacellaA,CettaF,SianesiM."Adenomatous
REFERENCES polypsofthegallbladder"adenomasofthegallbladder.HPB
Surg19913:251.
GRAPHICSViewAll
18.AlboresSaaverdraJ,HensonDE.Tumorsofthegallbladder
ALGORITHMS andtheextrahepaticbileduct,1725,USArmedForces
Algorithmgallbladderpolyps InstituteofPathology,Washington1989.
PICTURES 19.KozukaS,TsuboneN,YasuiA,HachisukaK.Relationof
StrawberrygallbladderGross adenomatocarcinomainthegallbladder.Cancer1982
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3/29/2017 Gallbladderpolypsandcholesterolosis

50:2226.
19.3 20.[Collectivereviewof503casesofsmallpolypoidlesions
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Gallbladderpolypsandcholesterolosis carcinomatousinvasion].NihonShokakibyoGakkaiZasshi
Find Print

198683:2086.
TOPICOUTLINE 21.McGregorJC,CordinerJW.Papillomaofthegallbladder.BrJ
Surg197461:356.
INTRODUCTION
EPIDEMIOLOGY 22.KANECF,BROWNCH,HOERRSO.Papillomaofthe
gallbladderreportofeightcases.AmJSurg195283:161.
CLASSIFICATION
23.TakiiY,ShiraiY,KaneharaH,HatakeyamaK.Obstructive
CHOLESTEROLOSISAND
jaundicecausedbyacholesterolpolypofthegallbladder:
CHOLESTEROLPOLYPS
reportofacase.SurgToday199424:1104.
Epidemiologyofcholesterolosis
24.ParrillaParicioP,GarcaOlmoD,PellicerFrancoE,etal.
Pathologyofcholesterolosis
Gallbladdercholesterolosis:anaetiologicalfactorinacute
ADENOMYOMATOSIS pancreatitisofuncertainorigin.BrJSurg199077:735.
Epidemiologyof
25.MITTYWFJr,ROUSSELOTLM.Cholesterosisofthegall
adenomyomatosis
bladder.Gastroenterology195732:910.
Pathologyofadenomyomatosis
26.KmiotWA,PerryEP,DonovanIA,etal.Cholesterolosisin
INFLAMMATORYPOLYPS
patientswithchronicacalculousbiliarypain.BrJSurg
ADENOMAS 199481:112.
Pathologyofadenomas 27.KogaA,WatanabeK,FukuyamaT,etal.Diagnosisand
MISCELLANEOUSPOLYPS operativeindicationsforpolypoidlesionsofthegallbladder.
CLINICALFEATURES ArchSurg1988123:26.
RISKOFMALIGNANCY 28.IshikawaO,OhhigashiH,ImaokaS,etal.Thedifferencein
malignancybetweenpedunculatedandsessilepolypoid
DIAGNOSIS
lesionsofthegallbladder.AmJGastroenterol1989
Ultrasonography 84:1386.
Oralcholecystography
29.MeacockLM,SellarsME,SidhuPS.Evaluationofgallbladder
Computedtomography
andbiliaryductdiseaseusingmicrobubblecontrast
Endoscopicultrasonography enhancedultrasound.BrJRadiol201083:615.
Positronemissiontomography
30.LiD,DongBW,WuYL,YanK.Imagedirectedandcolor
(PET)
Dopplerstudiesofgallbladdertumors.JClinUltrasound
MANAGEMENT 199422:551.
Polypsalongwithgallstonesor
31.HirookaY,NaitohY,GotoH,etal.Differentialdiagnosisof
primarysclerosingcholangitis
gallbladdermassesusingcolourDopplerultrasonography.J
Symptomaticpatients
GastroenterolHepatol199611:840.
Asymptomaticpatients
32.LiD.[ColorDopplerflowimagingingallbladdertumors].
Lesionslargerthan18to20
ZhonghuaYiXueZaZhi199272:394.
mm
Lesionsfrom10to20mm 33.PradhanS,ShuklaVK,AgrawalS,etal.Sonographicand
Lesionsfrom5to10mm colourdopplermorphologyincarcinomagallbladder.Indian
JCancer200239:143.
Lesionssmallerthan5mm
SUMMARYAND 34.SatoM,IshidaH,KonnoK,etal.Localizedgallbladder
RECOMMENDATIONS carcinoma:sonographicfindings.AbdomImaging2001
26:619.
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35.KomatsudaT,IshidaH,KonnoK,etal.Gallbladder
GRAPHICSViewAll carcinoma:colorDopplersonography.AbdomImaging
200025:194.
ALGORITHMS
Algorithmgallbladderpolyps 36.HayakawaS,GotoH,HirookaY,etal.ColourDoppler
guidedspectralanalysisofgallbladderwallflow.J
PICTURES
GastroenterolHepatol199813:181.
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37.KubotaK,BandaiY,NoieT,etal.Howshouldpolypoid
19.3 lesionsofthegallbladderbetreatedintheeraof
laparoscopiccholecystectomy?Surgery1995117:481.
38.BerkRN,vanderVegtJH,LichtensteinJE.Thehyperplastic
Gallbladderpolypsandcholesterolosis cholecystoses:cholesterolosisandadenomyomatosis.
Find
Print
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TOPICOUTLINE 39.FurukawaH,TakayasuK,MukaiK,etal.CTevaluationof
INTRODUCTION smallpolypoidlesionsofthegallbladder.
Hepatogastroenterology199542:800.
EPIDEMIOLOGY
40.ChoiJH,YunJW,KimYS,etal.Preoperativepredictive
CLASSIFICATION
factorsforgallbladdercholesterolpolypsusingconventional
CHOLESTEROLOSISAND diagnosticimaging.WorldJGastroenterol200814:6831.
CHOLESTEROLPOLYPS
41.LouMW,HuWD,FanY,etal.CTbiliarycystoscopyof
Epidemiologyofcholesterolosis
gallbladderpolyps.WorldJGastroenterol200410:1204.
Pathologyofcholesterolosis
42.SugiyamaM,XieXY,AtomiY,SaitoM.Differentialdiagnosis
ADENOMYOMATOSIS
ofsmallpolypoidlesionsofthegallbladder:thevalueof
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adenomyomatosis
43.SugiyamaM,AtomiY,YamatoT.Endoscopic
Pathologyofadenomyomatosis
ultrasonographyfordifferentialdiagnosisofpolypoidgall
INFLAMMATORYPOLYPS bladderlesions:analysisinsurgicalandfollowupseries.
ADENOMAS Gut200046:250.
Pathologyofadenomas 44.KimuraK.[Diagnosisforpedunculatedpolypoidlesionsof
MISCELLANEOUSPOLYPS thegallbladderbyendoscopicultrasonography].Nihon
ShokakibyoGakkaiZasshi199794:249.
CLINICALFEATURES
RISKOFMALIGNANCY 45.MatsumotoJ.Endoscopicultrasonographydiagnosisof
gallbladderlesions.Endoscopy199830Suppl1:A124.
DIAGNOSIS
46.AzumaT,YoshikawaT,AraidaT,TakasakiK.Differential
Ultrasonography
diagnosisofpolypoidlesionsofthegallbladderby
Oralcholecystography
endoscopicultrasonography.AmJSurg2001181:65.
Computedtomography
47.MugurumaN,OkamuraS,IchikawaS,etal.Endoscopic
Endoscopicultrasonography
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primarysclerosingcholangitis
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Symptomaticpatients
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PICTURES gallbladderpolyps.JGastroenterolHepatol200924:219.
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NihonShokakibyoGakkaiZasshi197976:91.

Gallbladderpolypsandcholesterolosis Find
Print

TOPICOUTLINE

INTRODUCTION
EPIDEMIOLOGY
CLASSIFICATION
CHOLESTEROLOSISAND
CHOLESTEROLPOLYPS
Epidemiologyofcholesterolosis
Pathologyofcholesterolosis
ADENOMYOMATOSIS
Epidemiologyof
adenomyomatosis
Pathologyofadenomyomatosis
INFLAMMATORYPOLYPS
ADENOMAS
Pathologyofadenomas
MISCELLANEOUSPOLYPS
CLINICALFEATURES
RISKOFMALIGNANCY
DIAGNOSIS
Ultrasonography
Oralcholecystography
Computedtomography
Endoscopicultrasonography
Positronemissiontomography
(PET)
MANAGEMENT
Polypsalongwithgallstonesor
primarysclerosingcholangitis
Symptomaticpatients
Asymptomaticpatients
Lesionslargerthan18to20
mm
Lesionsfrom10to20mm
Lesionsfrom5to10mm
Lesionssmallerthan5mm
SUMMARYAND
RECOMMENDATIONS
REFERENCES

GRAPHICSViewAll

ALGORITHMS
Algorithmgallbladderpolyps
PICTURES
StrawberrygallbladderGross HelpimproveUpToDate.DidUpToDateansweryourquestion? Yes No
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