A retrospective histopathological analysis with clinicoradiological correlation of gallbladder diseases in a tertiary care centre in Bihar-  A retrospective study.

Shadan  Rabab; Zeenat Sarmadi  Imam; Deepak  Pankaj; Bipin  Kumar; Manish  Mandal; Sweta  Muni

doi:10.51168/sjhrafrica.v6i6.1808

Authors

Shadan Rabab Senior Resident, Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Zeenat Sarmadi Imam Associate Professor, Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Deepak Pankaj Associate Professor, Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Bipin Kumar Professor and HOD, Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Manish Mandal Professor and HOD, Department of Surgical Gastroenterology and Liver Transplant, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Sweta Muni Associate Professor, Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1808

Keywords:

Cholecystitis, Cholesterolosis, Cholelithiasis, Adenocarcinoma, Dysplasia, Gall bladder

Abstract

Background

Diseases of the gall bladder are a common health issue affecting the population worldwide. The spectrum of the disease ranges from inflammatory lesions to dysplasia and further extends to carcinomas. Histopathological examination is the gold standard diagnostic modality. The diagnostic process is amplified when histopathological findings are correlated with clinicoradiological features.

Aims and objectives: The study aims to highlight the histopathological spectrum of gall bladder lesions and it’s clinicoradiological correlation, thereby advancing the understanding of gall bladder pathology and its management.

Materials and methods

A retrospective observational study was conducted in the Pathology department at IGIMS, Patna. Cases were selected as per the inclusion and exclusion criteria from 3100 cholecystectomy samples received from January 2021 to December 2024. Details were collected from histopathology request forms and hospital records. Gross and microscopic features were analysed, and the parameters were calculated.

Results

The mean age of the patient was 42minus 4.76 years, with the majority in the age group of 41 to 50 years, having a female predominance. A significant association was observed between increased gall bladder wall thickness and adenocarcinoma. Cholecystectomy performed in patients less than 10 years of age had a direct relationship with choledochal cyst. Radiological and histopathological diagnosis corroborated in 89% percent of cases.

Conclusion

Most gall bladder lesions have an inflammatory origin, with a female preponderance. Cholecystectomy is the treatment of choice. Increasing incidence of malignancy emphasizes the importance of thorough histopathological examination in confirming the preoperative diagnosis and simultaneously sampling any suspicious areas to rule out an incidental finding of malignancy.

Recommendations

Routine histopathological examination of all cholecystectomy specimens is recommended to detect incidental malignancies. Prospective studies and improved radiological protocols are needed to enhance diagnostic accuracy and patient outcomes.

References

Kumari NS, Sireesha A, Srujana S, Kumar OS. Cholecystectomies - A 1.5-year histopathological study. IAIM. 2016;3(9):134-39.

Nordenstedt H, Mattsson F, El-Serag H, Lagergren JJ. Gallstones and cholecystectomy about the risk of intra- and extrahepatic cholangiocarcinoma. Br J Cancer. 2012;106(5):1011-15. https://doi.org/10.1038/bjc.2011.607 PMid:22240785 PMCid:PMC3305961

Lazcano-Ponce EC, Miquel JF, Muñoz N, Herrero R, Ferrecio C, Wistuba II, et al. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin. 2001; 51:349-64 https://doi.org/10.3322/canjclin.51.6.349 PMid:11760569

Thukral S, Roychoudhary AK, Bansal N, Rani E. Histopathological spectrum of gall bladder lesions in a tertiary care hospital in the Malwa belt: a hospital-based study. Ann Pathol Lab Med. 2018,5:878-881. https://doi.org/10.21276/APALM.2192

Mondal M, Maulik D, Biswas B, Sarkar G, Ghosh D. Histopathological spectrum of gall stone diseases from cholecystectomy specimens in rural areas of West Bengal, India: an approach of association between gall stone diseases and gall bladder carcinomas. Int J Community Med Public Heal. 2016,3:3229-35. https://doi.org/10.18203/2394-6040.ijcmph20163941

Mohan H, Punia RP, Dhawan SB, Ahal S, Sekhon MS. Morphological spectrum of gallstone disease in 1100 cholecystectomies in North India. Indian J Surg. 2005;67:140-42.

Srivastav AC, Srivastava M, Paswan R. Spectrum of clinicopathological presentations of gall bladder diseases in eastern UP. International Journal of Contemporary Medicine Surgery and Radiology. 2019;4(1):A18-A23. https://doi.org/10.21276/ijcmsr.2019.4.1.5

Kotasthane VD, Kotasthane DS. Histopathological spectrum of gall bladder diseases in cholecystectomy specimens at a rural tertiary hospital of Purvanchal in North India-does it differ from South India? Arch Cytol Histopathol Res. 2020;5(1):91-5. https://doi.org/10.18231/j.achr.2020.018

Rao JC, Adsay NV, Arola J, Tsui WM, Zen Y. Carcinoma of the gall bladder. In: Cree IA, editor. WHO classification of Tumours of the digestive system, 5th ed. Lyon: IARC; 2019. Pp.283-88.

Baseer M, Ali R, Ayub M, Rashid H, Mahmood A, Ahmed S. The frequency of incidence of gall bladder carcinomas after laproscopic cholecystectomies for carcinomas with gall stones. Ann Punjab Med Coll. 2019,13:130-32.

Tantia O, Jain M, Khanna S, Sen B. Incidental carcinoma gall bladder during laparoscopic cholecystectomy for symptomatic gallstone disease. Surg Endosc. 2009;23(9):2041-46. https://doi.org/10.1007/s00464-008-9950-8 PMid:18443860

Allen SN. Gallbladder disease: pathophysiology, diagnosis, and treatment. US Pharm. 2013;38(3):33-41.

Dowerah S, Deori R. A study of benign histopathological changes in cholecystectomy specimens: experience at a referral hospital. International Journal of Contemporary Medical Research. 2016;3(8):2392-94

Selvi TR, Sinha P, Subramaniam PM, Konapur PG, Prabha CV. A clinicopathological study of cholecystitis with special reference to analysis of cholelithiasis. Int J Basic Med Sci. 2011;2(2):68-72.

Mondal B, Maulik D, Biswas BK, Sarkar GN, Ghosh D. Histopathological spectrum of gallstone disease from cholecystectomy specimen in rural areas of West Bengal, India-an approach of association between gallstone disease and gallbladder carcinoma. Int J Community Med Public Health. 2016;3(11):3229-35. 7. https://doi.org/10.18203/2394-6040.ijcmph20163941

Dattal DS, Kaushik R, Gulati A, Sharma V. Morphological spectrum of gall bladder lesions and their correlation with cholelithiasis. Int J Res Med Sci. 2017;5(3):840-6. https://doi.org/10.18203/2320-6012.ijrms20170622

Agrawal R, Srivastava A, Mohan N, Arya A, Sharan J, Singh A. Histo-morphological study of mucosal changes in the gall bladder at a tertiary care centre. Ind J Pathol Oncol. 2018;5(3):398-404. https://doi.org/10.18231/2394-6792.2018.0077

Almas T, Murad MF, Khan MK, Ullah M, Nadeem F, Ehtesham M, et al. The Spectrum of Gallbladder Histopathology at a Tertiary Hospital in a Developing Country: A Retrospective Study. Cureus. 2020;12(8):e9627. https://doi.org/10.7759/cureus.9627

Butti AK, Yadav SK, Verma A, Das A, Naeem R, Chopra R, et al. Chronic calculus cholecystitis: Is histopathology essential post-cholecystectomy? Indian J Cancer. 2020;57:89-92. https://doi.org/10.4103/ijc.IJC_487_18 PMid:32129299

Siddiqui FG, Memon AA, Abro AH, Sasoli NA, Ahmad L. Routine histopathology of gallbladder after elective cholecystectomy for gallstones: Waste of resources or a justified act? BMC Surg. 2013;13:26. https://doi.org/10.1186/1471-2482-13-26 PMid:23834815 PMCid:PMC3710513

Awasthi N. A retrospective histopathological study of cholecystectomies. Int J Health Allied Sci. 2015;4:203-06.

https://doi.org/10.4103/2278-344X.160902

Soares KC, Goldstein SD, Ghaseb MA, Kamel I, Hackam DJ, Pawlik TM. Paediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int. 2017 Jun;33(6):637-50. https://doi.org/10.1007/s00383-017-4083-6 PMid:28364277

Ahrendt SA, Pitt HA. Biliary tract. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL (eds), Sabiston Textbook of Surgery, 17th edition; New Delhi: Elsevier, 2004; Pp. 1597-1641.

Agarwal S, Pandey P, Ralli Male, Agarwal R, Saxena P. Morphologic characterisation of 1693 cholecystectomy specimens- a study from a tertiary care center in northern India J Clin Diagn Res. 2018;12(1):5-9. https://doi.org/10.7860/JCDR/2018/30539.11034

Gupta V, Goel MM, Chandra A, Gupta P, Kumar S, Nigam J. Expression and clinicopathological significance of antiapoptosis protein survivin in gallbladder cancer. Indian J Pathol Microbiol. 2016;59:143-47 https://doi.org/10.4103/0377-4929.182035 PMid:27166029

Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P, Pazzi P, Mazzella G, Sama C, Roda E, Colecchia A. Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World journal of gastroenterology: WJG. 2008 Sep 14;14(34):5282. https://doi.org/10.3748/wjg.14.5282 PMid:18785280 PMCid:PMC2744058

Pradhan SB, Joshi MR, Vaidya A. Prevalence of different types of gallstone in patients with cholelithiasis at Kathmandu Medical College, Nepal. Kathmandu University Medical Journal. 2009;7(3):268-71. https://doi.org/10.3126/kumj.v7i3.2736 PMid:20071875

Siddiqui FG, Memon AA, Abro AH, Sasoli NA, Ahmad L. Routine histopathology of gallbladder after elective cholecystectomy for gallstones: waste of resources or a justified act?. BMC surgery. 2013 Dec;13:1-5.

https://doi.org/10.1186/1471-2482-13-26 PMid:23834815 PMCid:PMC3710513

Froutan Y, Alizadeh A, Mansour-Ghanaei F, Joukar F, Froutan H, Bagheri FB, Naghipour MR, Chavoshi SA. Gallstone disease found by ultrasonography in functional dyspepsia: prevalence and associated factors. International Journal of Clinical and Experimental Medicine. 2015 Jul 15;8(7):11283.

Sangma MM, Marak F. Clinicoetiopathological studies of acute cholecystitis. International Surgery Journal. 2016 Apr;3(2):914. https://doi.org/10.18203/2349-2902.isj20161167

Yadav A, Singh V, Chauhan K, Sharma SP, Verma N, Yadav A. Prevalence of gallstone in western Uttar Pradesh population. J Anat Sciences. 2016;24(1):38-42

Dixit R, Shukla VK. Why is gall bladder cancer common in the Gangetic belt? Sudhakaran PR (ed). Perspectives in cancer prevention - translational cancer research. Springer India. 2014. 145-51 https://doi.org/10.1007/978-81-322-1533-2_12

Ostapenko A, Liechty S, Kim M, Kleiner D. Accuracy of ultrasound in diagnosing gall bladder polyps at a community hospital. JSLS. 2020 Oct-Dec;24(4). https://doi.org/10.4293/JSLS.2020.00052