Gallbladder Polyps

Gallbladder Polyps.

Definition: Gallbladder Polyps are focal solid lesions on the mucosal surface of the gallbladder (inner wall).

Types:
Benign and Malignant

Epidemiology:
Polyps are relatively common with up to 7% frequency of the total population.

95% of all polyps are Benign.
Cholesterol polyps consist of >50% of all benign polyps.
30% are adenoma..
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Malignant polyps consist of 5% of all polyps, out of these adenocarcinoma consist of 90%. Other rare polyps could be metastatic deposits, Squamous cell Carcinoma.

Clinical Signs and Symptoms :
Typically asymptomatic, usually an incidental finding. However larger polyps may cause symptoms.

Ultrasound Findings.
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Ultrasound will reveal a non-shadowing polypoid ingrowth into the the gallbladder Lumen which could be immobile (usually) or pedunculated.

Usually small, measures <10mm.

Small polyps are echogenic and non-shadowing, while larger cholesterol polyps are usually hypoechoic.

Small polyps are smooth and often adheres to the wall, while larger polyps could be pedunculated, and show rough margins.

Adenomas tend to be larger, solitary and sessile with internal vascularity.

Polyps will remain fixed and not move on change of patient position(e.g Decubitus) , but calculus and sludge will move.

N/B it is highly difficult to differentiate between an adenoma and an adenocarcinoma.

Differential Diagnosis.
Tumefactive sludge, Gallbladder Carcinoma, Metastatic Deposits in Gallbladder and Adenomyomatosis.