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PATHOLOGY OF THE GALLBLADDER AND BILIARY TREE 53
ciated anomalous insertion of the pancreatic
duct. 10
Polyps
Gallbladder polyps are usually asymptomatic
lesions which are incidental findings in up to 5%
of the population. Occasionally they are the cause
of biliary colic. The most common type are cholesterol
polyps. These are reflective structures
which project into the gallbladder lumen but do
not cast an acoustic shadow. Unless on a long
stalk they will remain fixed on turning the patient
and are therefore distinguishable from stones
(Fig. 3.20).
There is an association between larger adenomatous
gallbladder polyps and subsequent carcinoma,
especially in patients over 50 years of age, so cholecystectomy
is often advised (Fig. 3.20C). Smaller
polyps of less than 1 cm in diameter may be safely
monitored with ultrasound. 11 In particular, gallbladder
polyps in patients with primary sclerosing
cholangitis have a much greater likelihood of
malignancy (40–60%). 12
Cholesterolosis
Also known as the ‘strawberry gallbladder’, this
gets its name because of the multiple tiny nodules
on the surface of the gallbladder mucosal lining.
GB
A
B
C
Figure 3.20 (A) Small polyp in the gallbladder lumen—no posterior shadowing is evident. (B) A gallbladder polyp on a
stalk moves with different patient positions. (C) Large, fleshy gallbladder polyp.