Gallbladder polyp
| Classification according to ICD-10 | |
|---|---|
| K82.8 | Other unspecified diseases of the gallbladder |
| ICD-10 online (WHO version 2019) | |
As gallbladder polyps protrusions are the gallbladder mucosa referred to a variety of causes may have. In 70% of the cases, these are not real polyps that are formed by the mucous membrane. Most of these so-called pseudopolyps consist of cholesterol deposits . Genuine polyps of the gallbladder can be benign tumors such as adenomas or malignant tumors such as gallbladder carcinoma . Because of the risk of malignant degeneration, polyps over 10 millimeters in size should have the gallbladder removed ( cholecystectomy ).
Classification and causes
In the literature, a distinction is made between pseudopolyps and true polyps.
Over 80% of gallbladder polyps are pseudopolyps, most of which are deposits of cholesterol (70% of all polyps). It is difficult to give a precise indication of the frequency, since in a large proportion of cases of cholecystectomies with the previously described gallbladder polyps no polyps are found in the pathological examination of the removed gallbladder. This could be due to the fact that gallstones or bile semolina are mistakenly mistaken for polyps in sonography , or that a cholesterol-containing pseudopolyp is abraded until the gallbladder is removed. Other pseudopolyps are adenomyomas and granulomas caused by irritation of the gallbladder wall, so-called inflammatory pseudopolyps.
Of the approximately 17% confirmed, true polyps, around half are benign tumors. Most of these are adenomas . Lipomas , leiomyomas , neurofibromas or neuroendocrine tumors are rare .
The other half are malignant tumors like gallbladder carcinoma . Less common are malignant lymphomas or metastases of other malignant tumors such as black skin cancer .
With these numbers, it should be noted that in the underlying studies, a cholecystectomy was rarely performed to confirm the diagnosis of a gallbladder polyp. If this is factored in, only about 0.6% of the polyps seen on ultrasound are confirmed benign or malignant tumors.
frequency
Estimates of the frequency of gallbladder polyps in the population vary between 0.3 and 9.5%. A study from Germany estimated the frequency to be less than 1.5%. In this study, men were more frequently affected than women, but the information on the gender ratio differs internationally.
Symptoms
Gallbladder polyps usually do not cause any symptoms and are mostly discovered by chance.
Diagnosis
The diagnosis is made by sonography . Here polyps show up as elevations in the gallbladder wall that protrude into the lumen , i.e. inwards. Pseudopolyps show a typical artifact called a "comet's tail". However, this is often missing, so that real and pseudopolypes cannot be reliably differentiated on ultrasound.
Differential diagnoses
There is a risk of confusion with gallstones adhering to the wall of the gallbladder and formations of bile semolina .
therapy
The scientific literature generally recommends cholecystectomy for polyps larger than 10 mm , as this is where the risk of developing cancer is greatest. Smaller polyps are handled very differently in terms of follow-up and therapy because of the lack of high-quality studies. In 2017, several European specialist societies presented a common guideline to standardize the recommendations. Pseudopolyps do not require any follow-up monitoring or specific therapy.
Web links
Individual evidence
- ↑ a b c Mohamed Elmasry, Don Lindop, Declan FJ Dunne, Hassan Malik, Graeme J. Poston: The risk of malignancy in ultrasound detected gallbladder polyps: A systematic review . In: International Journal of Surgery (London, England) . 33 Pt A, September 2016, ISSN 1743-9159 , p. 28-35 , doi : 10.1016 / j.ijsu.2016.07.061 , PMID 27465099 .
- ↑ a b c d Vincent M. Mellnick, Christine O. Menias, Kumar Sandrasegaran, Amy K. Hara, Ania Z. Kielar: Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation . In: Radio Graphics: A Review Publication of the Radiological Society of North America, Inc . tape 35 , no. 2 , March 2015, ISSN 1527-1323 , p. 387-399 , doi : 10.1148 / rg.352140095 , PMID 25763724 .
- ↑ Henrike Lenzen, Tim Lankisch: Gall bladder polyps in Michael P. Manns, Sabine Schneidewind (Ed): Practice of Hepatology . Springer, Berlin and Heidelberg 2016. Online , last accessed on November 26, 2019.
- ↑ a b Rebecca Wiles, Ruedi F. Thoeni, Sorin Traian Barbu, Yogesh K. Vashist, Søren Rafael Rafaelsen: Management and follow-up of gallbladder polyps . In: European Radiology . tape 27 , no. 9 , 2017, ISSN 0938-7994 , p. 3856-3866 , doi : 10.1007 / s00330-017-4742-y , PMID 28185005 , PMC 5544788 (free full text).