Int J Clin Exp Pathol 2015;8(9):11569-11578 www.ijcep.com /ISSN:1936-2625/IJCEP0012830
Original Article Polypoid lesions of the gallbladder: report of 160 cases with special reference to diagnosis and treatment in China Jingjing Guo1, Gang Wu1, Zhongwen Zhou2 Departments of 1General Surgery, 2Pathology, Huashan Hospital, Fudan University, Shanghai 200040, China Received July 13, 2015; Accepted August 23, 2015; Epub September 1, 2015; Published September 15, 2015 Abstract: Background: The preoperative diagnosis of gallbladder polypoid lesions is difficult, justifying the lack of consensus on the appropriate treatment. Objective: The aim of this study was to identify the characteristics of each type of polypoid lesion of the gallbladder and the indications for surgery. Methods: Between January 1999 and December 2012, clinical data were retrospectively correlated with the histopathologic characteristics of polypoid lesions in 160 patients who underwent cholecystectomy. Results: A total of 160 patients with benign polypoid lesions (including 49 tumor-like lesions and 75 adenomas) and 14 patients with malignant polypoid lesions (including 2 adenocarcinomas and 12 adenomas with malignant changes) were included in this study. One hundred and five (65.6%) of the patients had associated symptoms, and 70 (43.8%) had gallstones. Of the 49 patients with tumorlike lesions, 49 (100%) were correlated with chronic cholecystitis. A total of 72 (83.8%) patients with neoplasms had a single polyp compared with 25 (59.5%) of those with non-neoplastic polyps. The mean age of the patients with malignancy was 59.07±13.465 years, and 12 (85.7%) of these patients were over 50 years of age. The mean diameters of the benign and malignant polyps were 1.0±0.77 cm and 2.15±1.16 cm, respectively. Ten (100%) of the patients with malignancy had polyps of over 1 cm in size, as shown by ultrasound. Conclusion: Our findings indicate that tumor-like lesions, adenomas, and adenocarcinomas are the most common polypoid lesions of the gallbladder. Cholecystecomy should be done in patients with symptoms. The risk of malignancy is high in patients over 50 years of age; those with polyps with diameters of greater than 10 mm; and those with single polypoid lesions. The remainder of PLG patients without cholecystectomy should be followed up at regular intervals. Keywords: Polypoid lesions, gallbladder, diagnosis, treatment
Introduction Polypoid lesions of the gallbladder (PLGs) are lesions that protrude from the wall to the inside of the gallbladder. They are classified as nonneoplastic and neoplastic polyps. Nonneoplastic polyps include cholesterol, hyperplastic, and inflammatory polyps, adenomyomas, leiomyomas, fibromas, and lipomas. Neoplastic polyps include adenomas, adenocarcinomas, and squamous cell carcinomas [1]. According to the second edition of the WHO Histological Classification of Tumors of the Gallbladder and Extrahepatic Bile Ducts, cholesterol polyps, adenomyomatous hyperplasia, inflammatory polyps and xanthogranulomatous cholecystitis are all classified as tumor-like lesions [2].
PLGs are rare, and their true incidence is unknown. However, recent studies of healthy individuals have reported a prevalence of 5.6%6.9% in the western world [3], which is significantly lower than that in Asia [4, 5]. Although most gallbladder carcinomas evolve from dysplasia and carcinoma in situ, the role of gallbladder adenomas in the pathogenesis of gallbladder carcinoma is still controversial. As a result, the discovery of a gallbladder polyp on imaging can pose a difficult management problem. Most of these lesions are benign; however, due to the poor prognosis of gallbladder carcinoma, this diagnosis must not be missed. Although the incidence of carcinoma is not high in PLGs, it is essential to diagnose gallbladder cancer at an early stage to achieve a good therapeutic outcome.
Diagnosis and treatment of PLGs Table 1. Demographic and clinical characteristics of each group
n Sex Male Female Age (yr) ≤20 21~30 31~40 41~50 51~60 61~70 >70 History (month) ≤12 13~36 >36 Symotom Yes No Cholecystitis Yes No Operation LC OC
Tumor-like lesions 49 (30.6%)
Adenoma
Adenocarcinoma
75 (46.9%)
14 (8.8%)
Overall
P
160 0.59
24 (49%) 32 (42.7%) 4 (28.6%) 25 (51%) 43 (57.3%) 10 (71.4%) 52.22±12.76 52.29±12.53 59.07±13.465 0 1 (1.3%) 0 2 (4.1%) 3 (4%) 1 (7.1%) 7 (14.3%) 8 (10.7%) 1 (7.1%) 14 (28.6%) 21 (28%) 0 15 (30.6%) 24 (32%) 6 (42.9%) 4 (8.2%) 10 (13.3%) 3 (21.4%) 7 (14.3%) 8 (10.7%) 3 (21.4%) 39.68±55.27 33.25±68.32 102.03±201.848 26 (53.1%) 47 (62.7%) 10 (71.4%) 6 (12.2%) 13 (17.3%) 0 17 (34.7%) 15 (20%) 4 (28.6%)
10 (45.5%) 12 (54.5%) 52.05±9.717 0 0 2 (9.1%) 8 (36.4%) 9 (40.9%) 2 (9.1%) 1 (4.5%) 42.84±57.176 12 (54.5%) 3 (13.6%) 7 (31.8%)
70 (43.8%) 90 (56.3%) 52.83±12.38 1 (0.6%) 6 (3.8%) 18 (11.3%) 43 (26.9%) 54 (33.8%) 19 (11.9%) 19 (11.9%) 42.56±84.92 95 (59.4%) 22 (13.8%) 43 (26.9%)
0.274
0.41
0.509 35 (71.4%) 14 (28.6%)
50 (66.7%) 25 (33.3%)
9 (64.3%) 5 (35.7%)
11 (50%) 11 (50%)
105 (65.6%) 55 (34.4%)
49 (100%) 0
56 (74.7%) 19 (25.3%)
3 (21.4%) 11 (78.6%)
19 (86.4%) 3 (13.6%)
127 (79.4%) 33 (20.6%)
29 (59.2%) 20 (40.8%)
45 (60%) 40 (40)
5 (35.7%) 9 (64.3%)
10 (45.5%) 12 (54.5%)
89 (55.6%) 71 (44.4%)
0.000
0.264
In the current study, 160 patients with PLGs who underwent cholecystectomy were reviewed to correlate their clinical features with the histopathologic findings. The aim was to define the characteristics of PLGs to establish sound criteria for surgical indications for these patients and to determine the differences between benign and malignant PLGs. Materials and methods Patients Between 1999 and 2012, 160 patients who complied with the definition of PLGs underwent cholecystectomies at the Department of Surgery at Huashan Hospital, Fudan University, Shanghai, China. Clinical data, including age, sex, symptoms, physical findings, and preoperative diagnostic evaluation findings were correlated with the patients’ pathologic characteristics and PLG diagnoses. All of the patients were
11570
Adenoma associated with tumor-like lesions 22 (13.8%)
evaluated with ultrasonography (USG) before surgery was performed at the Ultrasonography Department of the 160 patients with PLGs, 34 (21.2%) who underwent cholecystectomy because of other gallbladder disease were not diagnosed with PLGs by USG preoperatively, while postoperative pathology indicated a PLG diagnosis. A total of 126 (78.8%) patients with concordant preoperative and postoperative diagnostic findings had PLGs. Polyp size, number, surface, shape, location and the presence of stones were evaluated in the preoperative USG reports, and the compatibility of these findings with the histopathological data were analyzed. According to the histopathological diagnoses, cholesterol polyps, adenomyomatous hyperplasia, inflammatory polyps and xanthogranulomatous cholecystitis were classified as tumor-like lesions and non-neoplasms. Adenoma and
Int J Clin Exp Pathol 2015;8(9):11569-11578
Diagnosis and treatment of PLGs Table 2. The gallstones of each group
Gallstone Yes No Number of stone 1 ≤2 (max) Size of stone (cm) ≤1 1~2 ≥2 Cholesterol crystal Yes No
Tumor-like lesions
Adenoma
Adenocarcinoma
Adenoma associated with tumor-like lesions
Overall
23 (46.9%) 26 (53.1%)
35 (46.7%) 40 (53.3%)
5 (35.7%) 9 (64.3%)
7 (31.8%) 15 (68.2%)
70 (43.8%) 90 (56.3%)
8 (34.8%) 15 (65.2%)
9 (25.7%) 26 (74.3%)
2 (40%) 3 (60%)
2 (28.6%) 5 (71.4%)
21 (30%) 49 (70%)
14 (60.9%) 4 (17.4%) 5 (21.7%)
32 (91.4%) 2 (5.7%) 1 (2.9%)
3 (60%) 1 (20%) 1 (20%)
6 (85.7%) 1 (14.3%) 0
55(78.6%) 8 (11.4%) 7 (10%)
3 (11.5%) 23 (88.5%)
3 (7.5%) 37 (92.5%)
0 9 (100%)
3 (20%) 12 (80%)
9 (10%) 81 (90%)
adenocarcinoma were classified as neoplasms. Benign gallbladder polyps were subdivided into the following classifications: tumor-like lesions, epithelial tumors (adenomas) and mesenchymatous tumors (fibroma, lipoma, and hemangioma). Malignant gallbladder polyps were considered gallbladder carcinomas. Statistical analysis Statistical significance was analyzed using the following tests, as appropriate: Student’s t test, the Mann-Whitney U test, the chi-square test, Fisher’s exact test, and the Kruskal-Wallis test. Statistical analyses were performed using SPSS 20.0 for Windows. A P value of 1 PE ≤1 >1 Echo pattern on US Hypoecho and Isoecho Hyperecho CA199 Normal Unmormal
Non-neoplasm Neoplasm 49 (35.5%) 89 (64.5%)
0.33 24 (49%) 25 (51%) 52.22±12.76 23 (46.9%) 26 (53.1%) 39.68±55.27 26 (53.1%) 19 (49.9)
36 (40.4%) 53 (59.6%) 53.36±12.84 35 (39.3%) 54 (60.7%) 44.07±102.85 57 (64%) 32 (36%)
0.619 0.386 0.782 0.48 0.536
35 (71.4%) 14 (28.6%)
59 (66.3%) 30 (33.7%) 0.822
23 (46.9%) 26 (53.1%)
40 (44.9%) 49 (55.1%)
49 (100%) 0 0.338±0.167
59 (66.3%) 30 (33.7%) 0.343±0.232
17 (63%) 10 (37%) 25 (59.5%) 17 (40.5%) 1.086±0.392 0.685±0.402 12 (52.2%) 11 (47.8%) 23 (85.2%) 4 (14.8%)
62 (84.9%) 11 (15.1%) 72 (83.8%) 15 (17.2%) 1.70±0.98 1.291±0.939 19 (31.7%) 41 (68.3%) 40 (58.8%) 28 (41.2%)
5 (23.8%) 16 (76.2%)
17 (28.3%) 43 (71.7%)
6 (85.71%) 1 (14.29%)
20 (86.96%) 3 (13.04%)
0.000
0.903 0.017 0.004 0.000 0.000 0.084 0.014 0.688
Descriptions of polyp shape were accessible for 3 of the patients with adenoma and tumorlike lesions, including 1 (33.3%) with a pedunculated and 2 (66.7%) with sessile polyps. In addition, the polyp surfaces of 2 (33.3%) and 4 (66.7%) of these patients were smooth and irregular, respectively. The four groups showed no significant differences in the polyp shape or
11574
P
surface descriptions (P=0.094 and P=0.374, respectively) (Table 3). The average thicknesses of the gallbladder wall (cm) for each group were 0.338±0.167, 0.33±0.21, 0.403±0.334 and 0.358±0.131, and these measurements did not significantly differ (P=0.504). The polyp sizes (cm) were 1.086±0.392, 1.52±0.78, 2.62±1.37 and 1.537± 0.907 as determined by USG, and they were 0.685±0.402, 1.14±0.82, 2.15±1.16 and 1.008±0.995 according to the pathology findings. These results were significantly different (P=0.001 and P50 80 (54.8%) 12 (85.7%) neoplasm group (66.3%) had History (month) 36.85±62.30 102.03±201.848 0.25 chronic cholecystitis, and this dif≤12 85 (58.2%) 10 (71.4%) 0.336 ference chronic cholecystitis was >12 61 (41.8%) 4 (28.6%) significant (P1 58 (70.7%) 10 (100%) polyps that were larger than 1 cm. PE ≤1 73 (74.5%) 1 (10%) 0.001 In the neoplasm group, 72 patients >1 24 (29.3%) 9 (90%) (83.8%) had a single polyp and 15 Echo pattern on US 0.043 (17.2%) had multiple polyps, and Hypoecho and Isoecho 20 (22.7%) 6 (50%) they were smaller than or equal to 1 cm in 40 (58.8%) and larger than Hyperecho 68 (77.3%) 6 (50%) 1 cm in 28 (41.2%). The numbers CA199 of polyps identified by both preopNormal 26 (86.67%) 7 (87.5%) 0.951 erative USG and postoperative PE Unmormal 4 (13.33%) 1 (12.5%) under direct vision significantly differed between the two groups female ratios were 24:25 and 36:53 (P=0.33), (P=0.017, P=0.004). The average size of the and those in the benign and malignant groups non-neoplastic polyps was 1.086±0.392 cm as were 66:80 and 4:10, respectively (P=0.231). determined by USG, and it was 0.685±0.402 These differences were not significant. The cm as shown by PE. For the neoplasm group, average gallbladder wall thickness as deterthese values were 1.70±0.98 cm and mined by pathological examination (PE) in the 1.291±0.939 cm, respectively. The differences non-neoplasm group was 0.338±0.167 cm, between the two groups were significant and it was 0.343±0.232 cm for the neoplasm (P
Original Article Polypoid lesions of the gallbladder: report of 160 cases with special reference to diagnosis and treatment in China Jingjing Guo1, Gang Wu1, Zhongwen Zhou2 Departments of 1General Surgery, 2Pathology, Huashan Hospital, Fudan University, Shanghai 200040, China Received July 13, 2015; Accepted August 23, 2015; Epub September 1, 2015; Published September 15, 2015 Abstract: Background: The preoperative diagnosis of gallbladder polypoid lesions is difficult, justifying the lack of consensus on the appropriate treatment. Objective: The aim of this study was to identify the characteristics of each type of polypoid lesion of the gallbladder and the indications for surgery. Methods: Between January 1999 and December 2012, clinical data were retrospectively correlated with the histopathologic characteristics of polypoid lesions in 160 patients who underwent cholecystectomy. Results: A total of 160 patients with benign polypoid lesions (including 49 tumor-like lesions and 75 adenomas) and 14 patients with malignant polypoid lesions (including 2 adenocarcinomas and 12 adenomas with malignant changes) were included in this study. One hundred and five (65.6%) of the patients had associated symptoms, and 70 (43.8%) had gallstones. Of the 49 patients with tumorlike lesions, 49 (100%) were correlated with chronic cholecystitis. A total of 72 (83.8%) patients with neoplasms had a single polyp compared with 25 (59.5%) of those with non-neoplastic polyps. The mean age of the patients with malignancy was 59.07±13.465 years, and 12 (85.7%) of these patients were over 50 years of age. The mean diameters of the benign and malignant polyps were 1.0±0.77 cm and 2.15±1.16 cm, respectively. Ten (100%) of the patients with malignancy had polyps of over 1 cm in size, as shown by ultrasound. Conclusion: Our findings indicate that tumor-like lesions, adenomas, and adenocarcinomas are the most common polypoid lesions of the gallbladder. Cholecystecomy should be done in patients with symptoms. The risk of malignancy is high in patients over 50 years of age; those with polyps with diameters of greater than 10 mm; and those with single polypoid lesions. The remainder of PLG patients without cholecystectomy should be followed up at regular intervals. Keywords: Polypoid lesions, gallbladder, diagnosis, treatment
Introduction Polypoid lesions of the gallbladder (PLGs) are lesions that protrude from the wall to the inside of the gallbladder. They are classified as nonneoplastic and neoplastic polyps. Nonneoplastic polyps include cholesterol, hyperplastic, and inflammatory polyps, adenomyomas, leiomyomas, fibromas, and lipomas. Neoplastic polyps include adenomas, adenocarcinomas, and squamous cell carcinomas [1]. According to the second edition of the WHO Histological Classification of Tumors of the Gallbladder and Extrahepatic Bile Ducts, cholesterol polyps, adenomyomatous hyperplasia, inflammatory polyps and xanthogranulomatous cholecystitis are all classified as tumor-like lesions [2].
PLGs are rare, and their true incidence is unknown. However, recent studies of healthy individuals have reported a prevalence of 5.6%6.9% in the western world [3], which is significantly lower than that in Asia [4, 5]. Although most gallbladder carcinomas evolve from dysplasia and carcinoma in situ, the role of gallbladder adenomas in the pathogenesis of gallbladder carcinoma is still controversial. As a result, the discovery of a gallbladder polyp on imaging can pose a difficult management problem. Most of these lesions are benign; however, due to the poor prognosis of gallbladder carcinoma, this diagnosis must not be missed. Although the incidence of carcinoma is not high in PLGs, it is essential to diagnose gallbladder cancer at an early stage to achieve a good therapeutic outcome.
Diagnosis and treatment of PLGs Table 1. Demographic and clinical characteristics of each group
n Sex Male Female Age (yr) ≤20 21~30 31~40 41~50 51~60 61~70 >70 History (month) ≤12 13~36 >36 Symotom Yes No Cholecystitis Yes No Operation LC OC
Tumor-like lesions 49 (30.6%)
Adenoma
Adenocarcinoma
75 (46.9%)
14 (8.8%)
Overall
P
160 0.59
24 (49%) 32 (42.7%) 4 (28.6%) 25 (51%) 43 (57.3%) 10 (71.4%) 52.22±12.76 52.29±12.53 59.07±13.465 0 1 (1.3%) 0 2 (4.1%) 3 (4%) 1 (7.1%) 7 (14.3%) 8 (10.7%) 1 (7.1%) 14 (28.6%) 21 (28%) 0 15 (30.6%) 24 (32%) 6 (42.9%) 4 (8.2%) 10 (13.3%) 3 (21.4%) 7 (14.3%) 8 (10.7%) 3 (21.4%) 39.68±55.27 33.25±68.32 102.03±201.848 26 (53.1%) 47 (62.7%) 10 (71.4%) 6 (12.2%) 13 (17.3%) 0 17 (34.7%) 15 (20%) 4 (28.6%)
10 (45.5%) 12 (54.5%) 52.05±9.717 0 0 2 (9.1%) 8 (36.4%) 9 (40.9%) 2 (9.1%) 1 (4.5%) 42.84±57.176 12 (54.5%) 3 (13.6%) 7 (31.8%)
70 (43.8%) 90 (56.3%) 52.83±12.38 1 (0.6%) 6 (3.8%) 18 (11.3%) 43 (26.9%) 54 (33.8%) 19 (11.9%) 19 (11.9%) 42.56±84.92 95 (59.4%) 22 (13.8%) 43 (26.9%)
0.274
0.41
0.509 35 (71.4%) 14 (28.6%)
50 (66.7%) 25 (33.3%)
9 (64.3%) 5 (35.7%)
11 (50%) 11 (50%)
105 (65.6%) 55 (34.4%)
49 (100%) 0
56 (74.7%) 19 (25.3%)
3 (21.4%) 11 (78.6%)
19 (86.4%) 3 (13.6%)
127 (79.4%) 33 (20.6%)
29 (59.2%) 20 (40.8%)
45 (60%) 40 (40)
5 (35.7%) 9 (64.3%)
10 (45.5%) 12 (54.5%)
89 (55.6%) 71 (44.4%)
0.000
0.264
In the current study, 160 patients with PLGs who underwent cholecystectomy were reviewed to correlate their clinical features with the histopathologic findings. The aim was to define the characteristics of PLGs to establish sound criteria for surgical indications for these patients and to determine the differences between benign and malignant PLGs. Materials and methods Patients Between 1999 and 2012, 160 patients who complied with the definition of PLGs underwent cholecystectomies at the Department of Surgery at Huashan Hospital, Fudan University, Shanghai, China. Clinical data, including age, sex, symptoms, physical findings, and preoperative diagnostic evaluation findings were correlated with the patients’ pathologic characteristics and PLG diagnoses. All of the patients were
11570
Adenoma associated with tumor-like lesions 22 (13.8%)
evaluated with ultrasonography (USG) before surgery was performed at the Ultrasonography Department of the 160 patients with PLGs, 34 (21.2%) who underwent cholecystectomy because of other gallbladder disease were not diagnosed with PLGs by USG preoperatively, while postoperative pathology indicated a PLG diagnosis. A total of 126 (78.8%) patients with concordant preoperative and postoperative diagnostic findings had PLGs. Polyp size, number, surface, shape, location and the presence of stones were evaluated in the preoperative USG reports, and the compatibility of these findings with the histopathological data were analyzed. According to the histopathological diagnoses, cholesterol polyps, adenomyomatous hyperplasia, inflammatory polyps and xanthogranulomatous cholecystitis were classified as tumor-like lesions and non-neoplasms. Adenoma and
Int J Clin Exp Pathol 2015;8(9):11569-11578
Diagnosis and treatment of PLGs Table 2. The gallstones of each group
Gallstone Yes No Number of stone 1 ≤2 (max) Size of stone (cm) ≤1 1~2 ≥2 Cholesterol crystal Yes No
Tumor-like lesions
Adenoma
Adenocarcinoma
Adenoma associated with tumor-like lesions
Overall
23 (46.9%) 26 (53.1%)
35 (46.7%) 40 (53.3%)
5 (35.7%) 9 (64.3%)
7 (31.8%) 15 (68.2%)
70 (43.8%) 90 (56.3%)
8 (34.8%) 15 (65.2%)
9 (25.7%) 26 (74.3%)
2 (40%) 3 (60%)
2 (28.6%) 5 (71.4%)
21 (30%) 49 (70%)
14 (60.9%) 4 (17.4%) 5 (21.7%)
32 (91.4%) 2 (5.7%) 1 (2.9%)
3 (60%) 1 (20%) 1 (20%)
6 (85.7%) 1 (14.3%) 0
55(78.6%) 8 (11.4%) 7 (10%)
3 (11.5%) 23 (88.5%)
3 (7.5%) 37 (92.5%)
0 9 (100%)
3 (20%) 12 (80%)
9 (10%) 81 (90%)
adenocarcinoma were classified as neoplasms. Benign gallbladder polyps were subdivided into the following classifications: tumor-like lesions, epithelial tumors (adenomas) and mesenchymatous tumors (fibroma, lipoma, and hemangioma). Malignant gallbladder polyps were considered gallbladder carcinomas. Statistical analysis Statistical significance was analyzed using the following tests, as appropriate: Student’s t test, the Mann-Whitney U test, the chi-square test, Fisher’s exact test, and the Kruskal-Wallis test. Statistical analyses were performed using SPSS 20.0 for Windows. A P value of 1 PE ≤1 >1 Echo pattern on US Hypoecho and Isoecho Hyperecho CA199 Normal Unmormal
Non-neoplasm Neoplasm 49 (35.5%) 89 (64.5%)
0.33 24 (49%) 25 (51%) 52.22±12.76 23 (46.9%) 26 (53.1%) 39.68±55.27 26 (53.1%) 19 (49.9)
36 (40.4%) 53 (59.6%) 53.36±12.84 35 (39.3%) 54 (60.7%) 44.07±102.85 57 (64%) 32 (36%)
0.619 0.386 0.782 0.48 0.536
35 (71.4%) 14 (28.6%)
59 (66.3%) 30 (33.7%) 0.822
23 (46.9%) 26 (53.1%)
40 (44.9%) 49 (55.1%)
49 (100%) 0 0.338±0.167
59 (66.3%) 30 (33.7%) 0.343±0.232
17 (63%) 10 (37%) 25 (59.5%) 17 (40.5%) 1.086±0.392 0.685±0.402 12 (52.2%) 11 (47.8%) 23 (85.2%) 4 (14.8%)
62 (84.9%) 11 (15.1%) 72 (83.8%) 15 (17.2%) 1.70±0.98 1.291±0.939 19 (31.7%) 41 (68.3%) 40 (58.8%) 28 (41.2%)
5 (23.8%) 16 (76.2%)
17 (28.3%) 43 (71.7%)
6 (85.71%) 1 (14.29%)
20 (86.96%) 3 (13.04%)
0.000
0.903 0.017 0.004 0.000 0.000 0.084 0.014 0.688
Descriptions of polyp shape were accessible for 3 of the patients with adenoma and tumorlike lesions, including 1 (33.3%) with a pedunculated and 2 (66.7%) with sessile polyps. In addition, the polyp surfaces of 2 (33.3%) and 4 (66.7%) of these patients were smooth and irregular, respectively. The four groups showed no significant differences in the polyp shape or
11574
P
surface descriptions (P=0.094 and P=0.374, respectively) (Table 3). The average thicknesses of the gallbladder wall (cm) for each group were 0.338±0.167, 0.33±0.21, 0.403±0.334 and 0.358±0.131, and these measurements did not significantly differ (P=0.504). The polyp sizes (cm) were 1.086±0.392, 1.52±0.78, 2.62±1.37 and 1.537± 0.907 as determined by USG, and they were 0.685±0.402, 1.14±0.82, 2.15±1.16 and 1.008±0.995 according to the pathology findings. These results were significantly different (P=0.001 and P50 80 (54.8%) 12 (85.7%) neoplasm group (66.3%) had History (month) 36.85±62.30 102.03±201.848 0.25 chronic cholecystitis, and this dif≤12 85 (58.2%) 10 (71.4%) 0.336 ference chronic cholecystitis was >12 61 (41.8%) 4 (28.6%) significant (P1 58 (70.7%) 10 (100%) polyps that were larger than 1 cm. PE ≤1 73 (74.5%) 1 (10%) 0.001 In the neoplasm group, 72 patients >1 24 (29.3%) 9 (90%) (83.8%) had a single polyp and 15 Echo pattern on US 0.043 (17.2%) had multiple polyps, and Hypoecho and Isoecho 20 (22.7%) 6 (50%) they were smaller than or equal to 1 cm in 40 (58.8%) and larger than Hyperecho 68 (77.3%) 6 (50%) 1 cm in 28 (41.2%). The numbers CA199 of polyps identified by both preopNormal 26 (86.67%) 7 (87.5%) 0.951 erative USG and postoperative PE Unmormal 4 (13.33%) 1 (12.5%) under direct vision significantly differed between the two groups female ratios were 24:25 and 36:53 (P=0.33), (P=0.017, P=0.004). The average size of the and those in the benign and malignant groups non-neoplastic polyps was 1.086±0.392 cm as were 66:80 and 4:10, respectively (P=0.231). determined by USG, and it was 0.685±0.402 These differences were not significant. The cm as shown by PE. For the neoplasm group, average gallbladder wall thickness as deterthese values were 1.70±0.98 cm and mined by pathological examination (PE) in the 1.291±0.939 cm, respectively. The differences non-neoplasm group was 0.338±0.167 cm, between the two groups were significant and it was 0.343±0.232 cm for the neoplasm (P
