Cholecystectomy Specimens: Histopathological Assessment of 923 Cases with Emphasis on Unpredictable Diagnosis

Abstract

Introduction: Cholecystectomy specimens show wide clinicopathological spectrum varying from common nonneoplastic diseases to rare neoplastic lesions. Often, Gall bladder disease is diagnosed on the basis of clinical and radiological findings, but histopathology remains the gold standard for the final diagnosis. Intraoperative frozen section followed by histopathological examination of the cholecystectomy specimen which aid in the diagnosis of the incidental carcinomas. Aim: To analyse the histomorphological findings of cholecystectomy specimens with emphasis on unpredictable diagnosis. Materials and Methods: The retrospective study was conducted from January 2017 to May 2020 in the Department of Pathology at a tertiary care centre in Udaipur. A total of 923 cholecystectomy specimens were evaluated for Histopathological examination. Intraoperative Frozen sections were also studied in clinically suspicious cases. Results were analysed using SPSS version 21. Quantitative variables were expressed as mean±Standard Deviation (SD), whereas qualitative variables were expressed as absolute and relative frequencies. Results: Cholecystectomy specimens were examined over a wide age range of 22 years to 88 years of age. The male to female ratio was found to be 1:2.27 in non-neoplastic cases and 1:6.28 in neoplastic cases. On microscopy, the most common histopathological lesion encountered was Chronic cholecystitis (766 cases, 82.99%). Other non-neoplastic pathology included acute cholecystitis (36 cases, 3.9%), cholesterolosis (20 cases, 2.16%), gangrenous cholecystitis (15 cases, 1.6%), adenomyomatous hyperplasia (9 cases, 0.97%), Empyema (6 cases, 0.65%), Mucocele (5 cases, 0.54%), Xanthogranulomatous cholecystitis (3 cases, 0.32%), and others (12 cases, 1.30%). Neoplastic lesions included Carcinoma (41cases, 4.44%), Biliary Intraepithelial Neoplasia (BilIN- 04 cases, 0.43%) and Intracholecystic papillary neoplasm (ICPN06 cases, 0.65%). In eight (0.87%) cases we found unexpected histopathological diagnosis not correlating with the clinical findings and two cases showed the presence of incidental Gall Bladder (GB) carcinoma. Conclusion: Histopathological examination of cholecystectomy specimens assist in confirming the preoperative diagnosis and proper sampling from any thick wall or suspicious area helps to rule out any incidental findings of dysplasia or malignancy. Frozen sections should be carried out in suspicious cases that further aid in the proper management of the patient.

Keywords

• carcinoma
• histomorphology
• cholecystitis
• intracholecystic papillary neoplasm