Histomorphological Spectrum of Cholecystectomy Specimen and Incidence of Unexpected Primary Carcinoma Gall Bladder- Review of Cholecystectomy Specimens from A North Indian Hospital

  • Aruna Chhikara
  • B. S. Johal
Keywords: Cholecystitis, Cholelithiasis, Unexpected Primary Gall bladder carcinoma, histomorphology

Abstract

Background: Cholecystectomy is one of the most commonly performed surgery in the world. Cholelithiasis is the most common indication for elective cholecystectomy. The incidence of Unexpected primary carcinoma gall bladder varies from 0.23 to 1.9%.   Method: Histomorphological spectrum in 367 cholecystectomy spectrum was studied retrospectively.   Results: There was a preponderance of females, with male to female ratio of 1: 2.4. The mean age of the cases was 49.9 years. Most of the cases were in 4th and 5th decades of life. Chronic cholecystitis was the most common histological findings seen in 91% cases. Associated cholelithiasis was present in 219/367 cases. Other lesions observed were acute cholecystitis (3.8%), acute on chronic cholecystitis (1%), adenomyomatosis (0.5%) follicular cholecystitis (0.5%) and xanthogranulomatous cholecystitis (0.5%). Dysplasia was seen in 0.3% cases. Eleven cases of adenocarcinoma were notices, two including Unexpected primary gall bladder carcinoma.   Conclusion: Cholecystectomy specimens show varied histomorphological spectrum. Gross examination of the specimen does not rule out underlying premalignant or malignant condition. A keen histopathological examination of all cholecystectomy specimens must be done.

Author Biographies

Aruna Chhikara
Department of Laboratory Sciences, Johal Multispeciality Hospital, Hoshiarpur Road, Rama Mandi, Jalandhar, Punjab 144005
B. S. Johal
Johal Multispeciality Hospital, Jalandhar, Punjab-144005

References

Mohan H, Punia RPS, Dhawan SB, Ahal S, Sekhon MS. Morphological spectrum of gallstones disease in 1100 cholecytectomies in north India. Indian J Surg. 2005; 67(3): 140-02.

Awasthi N. A retrospective histopathological study of cholecystectomies. Int J Health Allied Sci. 2015; 4: 203-06.

Basak F, Habahceci M, Canbak T, Sisik A, Acar A, Yucel M et al. Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1747 elective laparoscopic cholecystectomy cases. Ann R Coll Surg Eng. 2016 Apr; 98(4):280-83.

Agarwal AK, Kalayarasan R, Singh S, Javed A, Sakhuja P. All cholecystectomy specimens must be sent for histopathology to detect inapparent Gall bladder cancer. HPB (oxford).2012 Apr; 14(4):269-73.

Kalita D, Pant L, Singh S, Jain G, Kudesia M, Gupta K et al. Impact of routine histopathological examination of gall bladder specimens on early detection of malignancy- a study of 4115 cholecystectomy specimens. Asian Pac J cancer Prev. 2013; 14: 3315-18.

Sangwan MK, Sangwan V, Garg MK, Singla D, Malik P, Duhan A. Incidental carcinoma of gall bladder in North India: Is routine histopathology of all cholecystectomy specimens justified? Int Surg J.2015 Nov; 2(4): 465-70.

Abro AH, Haider Z, Ahmad S. Helicobacter pylori Infection in patients with Calcular Cholecystitis: A Hospital Based Study. J Ayub Med Coll Abbottabad. 2011 Jan-Mar; 23(1):30-33.

Kafle SU, Sinha AK, Pandey SR. Histomorphology spectrum of gall bladder pathology in cholecystectomy specimens with clinical diagnosis of chronic cholecystitis. JNMA J Nepal Med Assoc. 2013 Oct- Dec; 52(192): 600-07.

Singh A, Singh G, Kaur K, Goyal G, Saini G, Sharma D. Histopathological changes in gall bladder mucosa associated with cholelithiasis: A prospective study. Niger J surg.2019 Jan –Jun; 25(1):21-25.

Kotasthane VD, Kotasthane DS. Histopathological spectrum of gall bladder diseases in cholecystectomy specimens at a rural tertiary hospital of Purvanchal in North India- Does it differ from South India? P Arch Cytol Histopathol Res.2020; 5(1): 91-95.

Zaki M, Al-Refeidi A. Histological changes in the Human Gallbladder Epithelium associated with gallstones. OMJ. 2009 Oct; 24(4): 269-73.

Gupta SC, Misra V, Singh PA, Roy A, Misra SP, Gupta AK. Gallstones and carcinoma gallbladder. Indian J Pathol Microbiol. 2000; 43(1):147-54.

Sood S, Kumar R, Varshney A, Sharma VK, Mohan A, Wadhwa B et al. Histopathological study of Non neoplastic gall bladder diseases with special reference to mucin histochemistry. Annals of Applied Bioscience.2016; 3(2):189-95.

Selvi TR, Sinha P, Subramaniam PM, Konapur PG, Prabha CV. A clinicopathological study of cholecystitis with special reference to analysis of cholelithiasis. Int J of Bas Med Sci. 2011; 2(2):68-72.

Mathur SK, Duhan A, Singh S, Aggarwal M, Aggarwal G, Sen R, Singh S, Garg S. Correlation of gallstone characteristics with mucosal changes in gall bladder. Trop gastroenterol. 2012 Jan-Mar; 33(1):39-44.

Pradhan SB, Joshi MR, Vaidya A. Prevalence of different types of gallstone in the patients with cholelithiasis at Kathmandu Medical College, Nepal. Kathmandu Univ Med J. 2009 Jul-Sept; 27(7):268-71.

Meirelles Costa AL, Bresciani CJ, Perez RO, Bresciani BH, Soqueiran A, Cecconello I. Are histological alterations observed in the gall bladder precancerous lesions? Clinics (Sao Paulo).2010 Feb; 65(2):143-50.

Kaur A, Dubey V.K., Mehta K.S. Gallbladder Mucosal Changes Associated with Chronic Cholecystitis and Their Relationship with Carcinoma Gallbladder. JK science. 2012; 14(2): 89-92.

Vahini G, Premalatha P, Mathi A, Krishna R, Renuka IV. A Clinicopathological Study of Gallbladder Lesions. IOSR-JDMS. 2015; 14(2):15-20.

Terada T. Histopathologic features and frequency of gall bladder lesions in consecutive 540 cholecystectomies. Int J Clin Exp Pathol. 2013 Jan-Mar; 6(1):91-96.

Baig SJ, Biswas S, Das S, Basu K, Chattopadhyay G. Histopathological changes in gall bladder mucosa in cholelithiasis: correlation with chemical composition of gall stones. Trop Gastroenterol. 2002 Jan- Mar; 23(1):25-27.

Russel PW, Brown CH. Primary carcinomas of gall bladder: report of 29 cases. Ann Surg. 1950 Jul; 132(1):121-28.

Mittal R, Jesudason MR, Nayal KS. Selective histopathology in cholecystectomy for gall stone disease. Indian J Gateronterol.2010 Jan; 29(1):26-30.

Bazoua G, Hazma N, Lazim T. Do we need histology for normal looking gall bladder? J Hepatobiliary Pancreati Surg.2007; 14(6):564-68

Darmas B, Mahmud S, Abbas A, Baker AL. Is there any justification for the routine histopathological examination of straightforward cholecystectomy specimens? Ann R Coll Surg Engl.2007 Apr; 89(3):238-41.

Published
2021-06-29
Section
Original Article