Patel Krashna, Dajani Khaled, Iype Satheesh, Chatzizacharias Nikolaos A, Vickramarajah Saranya, Singh Prateush, Davies Susan, Brais Rebecca, Liau Siong S, Harper Simon, Jah Asif, Praseedom Raaj K, Huguet Emmanuel L
Krashna Patel, Khaled Dajani, Satheesh Iype, Nikolaos A Chatzizacharias, Prateush Singh, Siong S Liau, Simon Harper, Asif Jah, Raaj K Praseedom, Emmanuel L Huguet, Department of Surgery, Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge CB20XZ, United Kingdom.
World J Gastrointest Surg. 2016 Oct 27;8(10):685-692. doi: 10.4240/wjgs.v8.i10.685.
To analyse the range of histopathology detected in the largest published United Kingdom series of cholecystectomy specimens and to evaluate the rational for selective histopathological analysis.
Incidental gallbladder malignancy is rare in the United Kingdom with recent literature supporting selective histological assessment of gallbladders after routine cholecystectomy. All cholecystectomy gallbladder specimens examined by the histopathology department at our hospital during a five year period between March 2008 and March 2013 were retrospectively analysed. Further data was collected on all specimens demonstrating carcinoma, dysplasia and polypoid growths.
The study included 4027 patients. The majority (97%) of specimens exhibited gallstone or cholecystitis related disease. Polyps were demonstrated in 44 (1.09%), the majority of which were cholesterol based (41/44). Dysplasia, ranging from low to multifocal high-grade was demonstrated in 55 (1.37%). Incidental primary gallbladder adenocarcinoma was detected in 6 specimens (0.15%, 5 female and 1 male), and a single gallbladder revealed carcinoma (0.02%). This large single centre study demonstrated a full range of gallbladder disease from cholecystectomy specimens, including more than 1% neoplastic histology and two cases of macroscopically occult gallbladder malignancies.
Routine histological evaluation of all elective and emergency cholecystectomies is justified in a United Kingdom population as selective analysis has potential to miss potentially curable life threatening pathology.
分析英国已发表的最大系列胆囊切除术标本中检测到的组织病理学范围，并评估选择性组织病理学分析的合理性。
在英国，偶然发现的胆囊恶性肿瘤很少见，近期文献支持对常规胆囊切除术后的胆囊进行选择性组织学评估。对2008年3月至2013年3月的五年期间我院病理科检查的所有胆囊切除术胆囊标本进行回顾性分析。收集了所有显示癌、发育异常和息肉样生长的标本的进一步数据。
该研究纳入了4027例患者。大多数（97%）标本表现出与胆结石或胆囊炎相关的疾病。44例（1.09%）标本显示有息肉，其中大多数为胆固醇性息肉（41/44）。55例（1.37%）标本显示有发育异常，范围从低级别到多灶性高级别。偶然发现原发性胆囊腺癌6例（0.15%，5例女性和1例男性），1例胆囊显示有癌（0.02%）。这项大型单中心研究展示了胆囊切除术标本中各种胆囊疾病，包括超过1%的肿瘤组织学以及2例肉眼隐匿性胆囊恶性肿瘤。
在英国人群中，对所有择期和急诊胆囊切除术进行常规组织学评估是合理的，因为选择性分析有可能遗漏潜在可治愈的危及生命的病理学病变。
