Download
gall bladder polyps n.
Skip this Video
Loading SlideShow in 5 Seconds..
GALL BLADDER POLYPS PowerPoint Presentation
Download Presentation
GALL BLADDER POLYPS

GALL BLADDER POLYPS

818 Vues Download Presentation
Télécharger la présentation

GALL BLADDER POLYPS

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. GALL BLADDER POLYPS Dr.Thomas Joseph

  2. GB polyp is the term used to describe any mucosal projection into the lumen of Gall bladder • Frequency ranges from 1 to 4% • Neoplastic or non-neoplastic • Non neoplastic lesions account for about 95% of the polyps

  3. Pathology • Cholesterol polyps • Adenomyoma • Inflammatory polyps • Adenomas • Miscellaneous polyps

  4. Cholesterol polyps • Most common type of GB polyps • Variant of cholesterolosis • Typically small (<10mm) • Pedunculated • Usually multiple

  5. Adenomyoma • Adenomyomatosis of the gall bladder localized to the fundus • Hemispheric bulge into the lumen • Usually single

  6. Adenomas • Neoplastic polyps • Usually single • Can be located anywhere in GB • Multiple in one third • Sometimes innumerable tiny mucosal polyps-multicentric papillomatosis • Co-exists with stones in half the cases

  7. Two histologic forms-papillary and non papillary • In papillary form there are branching tree like skeleton of connective tissue covered with tall columnar cells • In non papillary form there is a proliferation of glands encased by fibrous stroma

  8. Adenomas have premalignant potential • Frequency of progression from adenoma to carcinoma is much lower than that for colonic polyps • Virtually all adenomas with focus of carcinoma are more than 12 mm in diameter

  9. Inflammatory polyps • Solitary in half the cases • Small sessile lesions consisting of granulation and fibrous tissue infiltrated with lymphocytes and plasma cells

  10. Miscellaneous Polyps • Fibromas • Leiomyoma • Lipoma • Neurofibroma • Carcinoids • Heterotropic gastric glands • Peutz Jegher’s syndrome • Usually single

  11. Clinical features • Usually asymptomatic • May detach and behave like a stone • Biliary colic • Bile duct obstruction • Pancreatitis • Rarely cause acalculous cholecystitis or hemobilia

  12. Diagnosis • Usually an incidental finding on USG • Lesion inside the gall bladder without acoustic shadow • Will not change much with position • Size of more than 10mm predicts the risk of malignancy

  13. EUS improves diagnostic accuracy • 97% accurate in predicting benign nature • Tiny echogenic spots or aggregates of echogenic spots suggest Cholesterolosis • Multiple microcysts or comet tail artefact suggest Adenomyomatosis

  14. 18 flurodeoxyglucose PET scan – uptake predicted the presence of malignancy • Colour Doppler • Presence of colour signal • Diffuse and arborizing pattern • Blood flow velocity • Resistive index • CT/CT biliary cystoscopy

  15. Treatment • Patients with biliary colic and USG showing both stones and polyps should undergo cholecystectomy • If USG shows only polyps – decision depends on severity of symptoms and size of polyps

  16. Asymptomatic polyps less than 10mm can be followed up by USG • Lesions between 10mm and 18mm should undergo laproscopic cholecystectomy if the patient is an acceptable surgical candidate • If poor surgical risk  follow up by USG or cholecystography every 6 to 12 months

  17. Lesions more than 18 mm should be operated • Preferably open cholecystectomy

  18. Thank You