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home - Biliary - Biliary Cancers - Gallbladder Polyps Written by Dr Sebastian Zeki
Knowledge


Knows the epidemiology pathology and clinical presentation of bile
duct tumours

Can recognise the presentation of biliary tumours arising de novo or
in the context of PSC Can plan programme of investigations
including detailed staging

Understands treatment options including surgery chemotherapy and
endoscopic management

Skills
Aware of the treatment options including biliary drainage
chemotherapy radiotherapy photodynamic therapy or surgery

Understands rationale for selection of particular therapy in individual
patients

Awareness of the diagnostic modalities including CT MRI scanning
brush cytology intra ductal cholangioscopy and biopsy

Behaviours
Understands importance of multidisciplinary team of oncologist
surgeon radiologist histopathologist in decision making

Discusses cases with the specialist MDT

Gallbladder Polyps

MalignantAdenocarcinoma (most common malignancy and more common than adenomas)Other: Squamous cell carcinomas, mucinous cystadenomas, and adenoacanthomas (rare)USS: Homogeneous, heterogeneous sessile, or mass-like polypoid structures. Isoechogenic with the liver. Mulberry-like surface. Non-neoplastic Cholesterolosis and cholesterol polyps (=Accumulation of lipids in gallbladder mucosa.) AdenomaThey are rare benign epithelial tumors.Prevalence is < 0.5 %.On USS it is homogene-ous and isoechogenic with the liver. It has a smooth surface and no pedicle.Pathology shows benign glandular tumors composed of cells resembling biliary tract epithelium.Types include papillary and non papillary.Progression to cancer is size dependent. Gallbladder Polyp DiagnosisCT100% sensitive Contrast will also show cholesterol and inflammatory Benign Gallbladder Polyps Deposits of triglycerides, cholesterol precursors, and cholesterol esters into the gallbladder mucosa. Yellow deposits hyper-emic mucosa called “strawberry gallblad-der” Fat laden macrophages within elongated villiLipid crystallizes in cytoplasm- foamy under miscroscope 2/3rds are <1mm, the rest are poly-poid. Usually multiple.If polyps break off, can lead to same problems as gallstones. Adenomyomatosis (=gallbladder diverticulosis, cholecystitis glandularis proliferans, and adenomyomatous hyperplasia).Characterised by overgrowth of the mucosa, thickening of the muscle wall, and intra-mural diverticula.Epidemiology- Present in 1% cholecystectomies. Fluid filled mucosal pockets eventually herniate through the muscularis propria, forming cystic struc-tures visible as pools of bile in the gallbladder wall (Rokitansky-Aschoff sinuses) Types: 1. Localized, Fundal cystic polypoid nodule with thickened muscle layer. 2. Fundus,Polypoid mucosal projection 10-20mm width 3. Segmental type, a circumfer-ential ring divides the gallbladder into separate interconnected compartments. Inflammatory PolypsThese are the least common of the non-neoplastic polyps.They are sessile or pedunculated on USS.They are composed of granulation and fibrous tissue with plasma cells and lymphocytes.Polyps are usually 5-10mm long. Epidemiology Prevalence =12 % Risk factors as per gallstone formation. Other: Leiomyomas and lipomas. Neoplastic On USS:Usually<1 cm. EUS:Multiple tiny highly echogenic 1-3 mm spots. USS: Sessile echogenic mass with multiple microcysts (=dilated Rokitansky-Aschoff sinuses) or a comet tail artifact. Cholecystectomy indications:a) >1cmb) Symptomatic and any sizec) Increasing polyp sizeOtherwise repeat USS in 3-6monthsto ensure stable Malignant Gallbladder Polyps Or tubular, papillary, and mixed. Written by Dr Sebastian Zeki

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