Asymptomatic gall stone disease: A clinicopathological correlation

Abstract

Introduction: The widespread use of routine ultrasound (USG) of abdomen has led to increased detection of asymptomatic gallstone disease. The cholecystectomy is the gold standard treatment for symptomatic gallstones. However, there is always a controversy regarding management of silent gallstones. Aim: Present study designed to analyze the incidence of diverse histological changes found in gallbladder mucosa in silent gallstone diseases. Material and methods: We evaluated the mucosal changes in 135 specimens collected from patients undergoing routine cholecystectomy for silent gallstone disease for a period of 2 years. After gross examination, the specimens were formalin fixed. Sections were taken from different areas of formalin fixed gallbladder, stained with hematoxylin and eosin and examined under light microscope. Results: Abnormal mucosa was found in 86 (63,70%) cases of gallbladder grossly. On microscopy, chronic cholecystitis was found in 121 (89,63%) cases and xanthogranulomatous cholecystitis found in 4 cases (2,96%). Follicular cholecystitis was found in 5 (3,70%) cases. Cholesterolosis was found in 25 (18.52%) cases. Epithelial adenomatoid hyperplasia and papillary hyperplasia were found in 1 case each. Eighteen (13.33%) cases of Gastric metaplasia, 6 (4.44%) cases of intestinal metaplasia, 1 (0.74%) case of dysplasia and 2 cases (1.48%) adenocarcinoma were found. Discussion: Silent gallstone diseases, despite being asymptomatic, always show series of mucosal changes. Data revealed metaplastic changes especially intestinal metaplasia are associated significantly with dysplastic changes. Conclusion: Cholecystectomy should be done in all surgically fit silent gallstone cases and histopathological evaluation is important in every case to exclude metaplasia, dysplasia and carcinoma.