Incidental carcinoma of gallbladder in north India: is routine histopathology of all cholecystectomy specimens justified?

Abstract

Background: Gallstones can cause varied spectrum of histopathology. Xanthogranulomatous cholecystitis and metaplasia have been shown to have association with carcinoma gallbladder. Incidental carcinoma of the gallbladder is a nightmare for the patient. Routine histopathology of all cholecystectomy specimens is an effective policy for its early diagnosis and management. Methods: It is a retrospective study of histopathology of cholecystectomy specimens related to gallstones disease done at a rural government in north India. All patients with preoperative or intraoperative gross malignancy of gallbladder were excluded from study. Results: In our study, females were predominating over males with a ratio of 6.07:1. The mean of all patients was 44.16±14.64 years. Chronic cholecystitis was most common (69.81%) histopathological entity. Incidental carcinoma was also revealed in 1.9 % of the cases. Metaplasia and xanthogranulomatous cholecystitis was reported in about 6% cases. Mixed stones were most common type reported in 76.79% cases. Multiple stones (72.8%) were more common than single stones. Majority (58%) of the cases in our study were operated by laparoscopic technique. Gallbladder perforation was most common complication noticed in about 4.15% cases. Conclusions: Despite meticulous preoperative investigations and gross specimen examination, incidental carcinoma of gallbladder is a rule rather than exception in significant number of cases. A routine histopathology of specimen should be considered especially in high risk zones of carcinoma gallbladder.