Abstract
The present study aimed to clarify the endoscopic ultrasonography (EUS) features of nonneoplastic (cholesterol polyps and adenomyomatosis) and neoplastic (adenoma and adenocarcinoma) gallbladder polyps and to evaluate the effectiveness and limitation of EUS in the differential diagnosis of these lesions. We retrospectively compared EUS images with histologic findings in 29 surgical cases with gallbladder polyps with a diameter of 10 to 20 mm. Those cases were indicated for surgery based on the findings of a sessile appearance, a solitary lesion, low echogenicity, and/or a lobulated surface. Six of 10 cholesterol polyps were atypically seen as partially or completely hypoechoic due to predominant proliferation of glandular epithelia. Nine of 10 cholesterol polyps demonstrated an aggregation of hyperechoic spots, which represented multiple granules of cholesterosis. All adenomyomatoses (n = 10) showed multiple microcysts, which corresponded to proliferated Rokitansky-Aschoff sinuses. However, three of nine neoplastic lesions (three adenomas and six adenocarcinomas) showed one of these signs due to concomitant cholesterosis (n = 2) or proliferated Rokitansky-Aschoff sinuses (n = 1). In conclusion, 69% (20/29) of gallbladder polyps larger than 10 mm that were preoperatively suspected of malignancy were nonneoplastic. An aggregation of hyperechoic spots and multiple microcysts are considered to be important predictive factors for cholesterol polyps and adenomyomatosis, respectively. However, we should caution that these findings can also occur in neoplastic polyps when they contain a concomitant nonneoplastic component (cholesterosis or proliferated Rokitansky-Aschoff sinuses).
Similar content being viewed by others
References
Onoyama H, Yamamoto M, Takada M, Urakawa T, Ajiki T, Yamada I, Fujita T, Saitoh Y: Diagnostic imaging of early gallbladder cancer: retrospective study of 53 cases. World J Surg 23:708–712, 1999
Koga A, Yamauchi S, Izumi Y, Hamanaka N: Ultrasonographic detection of early and curable carcinoma of the gallbladder. Br J Surg 72:728–730, 1985
Jorgensen T, Jensen KH: Polyps in the gallbladder. A prevalence study. Scand J Gastroenterol 25:281–286, 1990
Segawa K, Arisawa T, Niwa Y, Suzuki T, Tsukamoto Y, Goto H, Hamajima E, Shimodaira M, Ohmiya N: Prevalence of gallbladder polyps among apparently healthy Japanese: ultrasonographic study. Am J Gastroenterol 87:630–633, 1992
Chen CY, Lu CL, Chang FY, Lee SD: Risk factors for gallbladder polyps in the Chinese population. Am J Gastroenterol 92:2066–2068, 1997
Boulton RA, Adams DH: Gallbladder polyps: when to wait and when to act. Lancet 349:817–818, 1997
Koga A, Watanabe K, Fukuyama T, Takiguchi S, Nakayama F: Diagnosis and operative indications for polypoid lesions of the gallbladder. Arch Surg 123:26–29, 1998
Ishikawa O, Ohhigashi H, Imaoka S, Nakaizumi A, Kitamura T, Sasaki Y, Shibata T, Wada A, Iwanaga T: The difference in malignancy between pedunculated and sessile polypoid lesions of the gallbladder. Am J Gastroenterol 84:1386–1390, 1989
Yang HL, Sun YG, Wang Z: Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 79:227–229, 1992
Mainprize KS, Gould SW, Gilbert JM:Surgical management of polypoid lesions of the gallbladder. Br J Surg 87:414–417, 2000
Csendes A, Burgos AM, Csendes P, Smok G, Rojas J: Late follow-up of polypoid lesions of the gallbladder smaller than 10, mm. Ann Surg 234:657–660, 2001
Moriguchi H, Tazawa J, Hayashi Y, Takenawa H, Nakayama E, Marumo F, Sato C: Natural history of polypoid lesions in the gall bladder. Gut 39:860–862, 1996
Azuma T, Yoshikawa T, Araida T, Takasaki K: Differential diagnosis of polypoid lesions of the gallbladder by endoscopic ultrasonography. Am J Surg 181:65–70, 2001
Choi WB, Lee SK, Kim MH, Seo DW, Kim HJ, Kim DI, Park ET, Yoo KS, Lim BC, Myung SJ, Park HJ, Min YI: A new strategy to predict the neoplastic polyps of the gallbladder based on a scoring system using EUS. Gastrointest Endosc 52:372–379, 2000
Sadamoto Y, Oda S, Tanaka M, Harada N, Kubo H, Eguchi T, Nawata H: A useful approach to the differential diagnosis of small polypoid lesions of the gallbladder, utilizing an endoscopic ultrasound scoring system. Endoscopy 34:959–965, 2002
Akiyama T, Sahara H, Seto K, Saitou H, Kiriyama M, Tomita F, Kosaka T, Kita I, Takashima S, Matsunou H: Gallbladder cancer associated with cholesterosis. J Gastroenterol 31:470–474, 1996
Aldridge MC, Gruffaz F, Castaing D, Bismuth H: Adenomyomatosis of the gallbladder. A premalignant lesion? Surgery 109:107–110, 1991
Katoh T, Nakai T, Hayashi S, Satake T: Noninvasive carcinoma of the gallbladder arising in localized type adenomyomatosis. Am J Gastroenterol 83:670–674, 1998
Kawarada Y, Sanda M, Mizumoto R, Yatani R: Early carcinoma of the gallbladder, noninvasive carcinoma originating in the Rokitansky-Aschoff sinus: a case report. Am J Gastroenterol 81:61–66, 1986
Kurihara K, Mizuseki K, Ninomiya T, Shoji I, Kajiwara S: Carcinoma of the gall-bladder arising in adenomyomatosis. Acta Pathol Jpn 43:82–85, 1993
Christensen AH, Ishak KG:Benign tumors and pseudotumors of the gallbladder. Report of 180 cases. Arch Pathol 90:423–432, 1970
Nakafuji H, Koike Y, Wakabayashi M, Furihata R, Maruyama Y, Ogata H: Three cases of early stage carcinoma of the gallbladder. Gastroenterol Jpn 16:134–140, 1981
Kozuka S, Tsubone N, Yasui A, Hachisuka K: Relation of adenoma to carcinoma in the gallbladder. Cancer 50:2226–2234, 1982
Aldridge MC, Bismuth H: Gallbladder cancer: the polyp-cancer sequence. Br J Surg 77:363–364, 1990
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Akatsu, T., Aiura, K., Shimazu, M. et al. Can Endoscopic Ultrasonography Differentiate Nonneoplastic from Neoplastic Gallbladder Polyps?. Dig Dis Sci 51, 416–421 (2006). https://doi.org/10.1007/s10620-006-3146-7
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10620-006-3146-7