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Gallbladder Polyps
Maria A. Manning, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Broadly defined as projection into gallbladder (GB) lumen
                • Nonneoplastic (most common)
                  • Cholesterol polyps: Reaction to chemical change/metabolic derangement of bile
                  • Injury-related polyps: Mucosal injury and regeneration
                    • Inflammatory polyps
                    • Fibromyoglandular polyp
                    • Polyploid metaplasia
                • Neoplastic
                  • Intracholecystic neoplasms (tumor-forming, preinvasive, adenomatous neoplasms)
                    • Parallel terminology used for intraductal neoplasms of pancreas and biliary tract
                    • Includes adenomas (pyloric gland, biliary, intestinal, tubular, tubulopapillary, papillary), papillary neoplasm, papillary carcinoma
                    • Pyloric gland adenoma (PGA) can be separately described pathologically; however, there are no distinguishing imaging features
            • Nonneoplastic Polyps

              • Cholesterol polyp (60-90% of all polyps)
                • Protrusion of subepithelial, cholesterol-filled macrophages, covered with single layer of epithelium and attached via delicate stalk
                • Included in cholesterosis spectrum
                  • Focal: Elongation and protrusion of lipid-filled macrophages into GB lumen
                  • Diffuse: Accumulation of cholesterol in subepithelial macrophages (strawberry GB)
                • Characteristic US imaging appearance
              • Injury-related polyps (5-10% of all polyps)
                • Fibrogranulomatous inflammatory response to chronic cholesterol deposition and mucosal irritation
                • Usually multiple and associated with gallstones/chronic cholecystitis
            • Neoplastic Polyps/Intracholecystic Neoplasm

              • Mass-forming preneoplastic and neoplastic epithelial proliferation that protrudes into lumen
              • Synonyms: Tumoral intraepithelial neoplasm (TIN), intracholecystic papillary-tubular neoplasm (ICPN, IPTN-GB)
              • Account for 5% of invasive GB carcinomas (most arise from flat dysplasia)

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Established Risk Factors for Gallbladder Carcinoma

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Jones MW et al: Gallbladder polyp. StatPearls Publishing [Internet]. 2021
                                            2. Szpakowski JL et al: Outcomes of gallbladder polyps and their association with gallbladder cancer in a 20-year cohort. JAMA Netw Open. 3(5):e205143, 2020
                                            3. Taskin OC et al: Gallbladder polyps: correlation of size and clinicopathologic characteristics based on updated definitions. PLoS One. 15(9):e0237979, 2020
                                            4. Taskin OC et al: Non-neoplastic polyps of the gallbladder: a clinicopathologic analysis of 447 cases. Am J Surg Pathol. 44(4):467-76, 2020
                                            5. Chatterjee A et al: Uncommon intraluminal tumors of the gallbladder and biliary tract: spectrum of imaging appearances. Radiographics. 39(2):388-412, 2019
                                            6. Wennmacker SZ et al: Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps. Surg Endosc. 33(5):1564-71, 2019
                                            7. WHO Classification of Tumours Editorial Board: WHO Classification of Tumours: Digestive System Tumours. 5th ed. International Agency for Research on Cancer, 2019
                                            8. Lin LY et al: A case of tubular adenoma of gallbladder diagnosed using contrast-enhanced ultrasonography. J Med Ultrasound. 26(4):218-21, 2018
                                            9. Wennmacker SZ et al: Transabdominal ultrasound and endoscopic ultrasound for diagnosis of gallbladder polyps. Cochrane Database Syst Rev. 8:CD012233, 2018
                                            10. Lamps LW: Gallbladder and extrahepatic bile ducts. In: Goldblum JR et al: Rosai and Ackerman's Surgical Pathology. 11th edition. Elsevier. 858-62, 2017
                                            11. Wiles R et al: Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery-European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol. 27(9):3856-66, 2017
                                            12. Elmasry M et al: The risk of malignancy in ultrasound detected gallbladder polyps: a systematic review. Int J Surg. 33 Pt A:28-35, 2016
                                            13. Gerstenmaier JF et al: Contrast-enhanced ultrasound in gallbladder disease: a pictorial review. Abdom Radiol (NY). 41(8):1640-52, 2016
                                            14. Mellnick VM et al: Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation. Radiographics. 35(2):387-99, 2015
                                            15. Sebastian S et al: Managing incidental findings on abdominal and pelvic CT and MRI, Part 4: white paper of the ACR Incidental Findings Committee II on gallbladder and biliary findings. J Am Coll Radiol. 10(12):953-6, 2013
                                            16. Terada T: Histopathologic features and frequency of gall bladder lesions in consecutive 540 cholecystectomies. Int J Clin Exp Pathol. 6(1):91-6, 2013
                                            17. Adsay V et al: Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases. Am J Surg Pathol. 36(9):1279-301, 2012
                                            18. Gallahan WC et al: Diagnosis and management of gallbladder polyps. Gastroenterol Clin North Am. 39(2):359-67, x, 2010
                                            19. Meacock LM et al: Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. Br J Radiol. 83(991):615-27, 2010
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Broadly defined as projection into gallbladder (GB) lumen
                                                          • Nonneoplastic (most common)
                                                            • Cholesterol polyps: Reaction to chemical change/metabolic derangement of bile
                                                            • Injury-related polyps: Mucosal injury and regeneration
                                                              • Inflammatory polyps
                                                              • Fibromyoglandular polyp
                                                              • Polyploid metaplasia
                                                          • Neoplastic
                                                            • Intracholecystic neoplasms (tumor-forming, preinvasive, adenomatous neoplasms)
                                                              • Parallel terminology used for intraductal neoplasms of pancreas and biliary tract
                                                              • Includes adenomas (pyloric gland, biliary, intestinal, tubular, tubulopapillary, papillary), papillary neoplasm, papillary carcinoma
                                                              • Pyloric gland adenoma (PGA) can be separately described pathologically; however, there are no distinguishing imaging features
                                                      • Nonneoplastic Polyps

                                                        • Cholesterol polyp (60-90% of all polyps)
                                                          • Protrusion of subepithelial, cholesterol-filled macrophages, covered with single layer of epithelium and attached via delicate stalk
                                                          • Included in cholesterosis spectrum
                                                            • Focal: Elongation and protrusion of lipid-filled macrophages into GB lumen
                                                            • Diffuse: Accumulation of cholesterol in subepithelial macrophages (strawberry GB)
                                                          • Characteristic US imaging appearance
                                                        • Injury-related polyps (5-10% of all polyps)
                                                          • Fibrogranulomatous inflammatory response to chronic cholesterol deposition and mucosal irritation
                                                          • Usually multiple and associated with gallstones/chronic cholecystitis
                                                      • Neoplastic Polyps/Intracholecystic Neoplasm

                                                        • Mass-forming preneoplastic and neoplastic epithelial proliferation that protrudes into lumen
                                                        • Synonyms: Tumoral intraepithelial neoplasm (TIN), intracholecystic papillary-tubular neoplasm (ICPN, IPTN-GB)
                                                        • Account for 5% of invasive GB carcinomas (most arise from flat dysplasia)

                                                      IMAGING

                                                      • General Features

                                                        • Ultrasonographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Established Risk Factors for Gallbladder Carcinoma

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Jones MW et al: Gallbladder polyp. StatPearls Publishing [Internet]. 2021
                                                                                      2. Szpakowski JL et al: Outcomes of gallbladder polyps and their association with gallbladder cancer in a 20-year cohort. JAMA Netw Open. 3(5):e205143, 2020
                                                                                      3. Taskin OC et al: Gallbladder polyps: correlation of size and clinicopathologic characteristics based on updated definitions. PLoS One. 15(9):e0237979, 2020
                                                                                      4. Taskin OC et al: Non-neoplastic polyps of the gallbladder: a clinicopathologic analysis of 447 cases. Am J Surg Pathol. 44(4):467-76, 2020
                                                                                      5. Chatterjee A et al: Uncommon intraluminal tumors of the gallbladder and biliary tract: spectrum of imaging appearances. Radiographics. 39(2):388-412, 2019
                                                                                      6. Wennmacker SZ et al: Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps. Surg Endosc. 33(5):1564-71, 2019
                                                                                      7. WHO Classification of Tumours Editorial Board: WHO Classification of Tumours: Digestive System Tumours. 5th ed. International Agency for Research on Cancer, 2019
                                                                                      8. Lin LY et al: A case of tubular adenoma of gallbladder diagnosed using contrast-enhanced ultrasonography. J Med Ultrasound. 26(4):218-21, 2018
                                                                                      9. Wennmacker SZ et al: Transabdominal ultrasound and endoscopic ultrasound for diagnosis of gallbladder polyps. Cochrane Database Syst Rev. 8:CD012233, 2018
                                                                                      10. Lamps LW: Gallbladder and extrahepatic bile ducts. In: Goldblum JR et al: Rosai and Ackerman's Surgical Pathology. 11th edition. Elsevier. 858-62, 2017
                                                                                      11. Wiles R et al: Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery-European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol. 27(9):3856-66, 2017
                                                                                      12. Elmasry M et al: The risk of malignancy in ultrasound detected gallbladder polyps: a systematic review. Int J Surg. 33 Pt A:28-35, 2016
                                                                                      13. Gerstenmaier JF et al: Contrast-enhanced ultrasound in gallbladder disease: a pictorial review. Abdom Radiol (NY). 41(8):1640-52, 2016
                                                                                      14. Mellnick VM et al: Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation. Radiographics. 35(2):387-99, 2015
                                                                                      15. Sebastian S et al: Managing incidental findings on abdominal and pelvic CT and MRI, Part 4: white paper of the ACR Incidental Findings Committee II on gallbladder and biliary findings. J Am Coll Radiol. 10(12):953-6, 2013
                                                                                      16. Terada T: Histopathologic features and frequency of gall bladder lesions in consecutive 540 cholecystectomies. Int J Clin Exp Pathol. 6(1):91-6, 2013
                                                                                      17. Adsay V et al: Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases. Am J Surg Pathol. 36(9):1279-301, 2012
                                                                                      18. Gallahan WC et al: Diagnosis and management of gallbladder polyps. Gastroenterol Clin North Am. 39(2):359-67, x, 2010
                                                                                      19. Meacock LM et al: Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. Br J Radiol. 83(991):615-27, 2010