109 Incidental Neoplasia in Gallbladder Polyps: A 5-Year Histopathological Analysis

Abstract Background Gallbladder polyps (GBPs) are identified in 0.3–12.3% of the general population, with malignancy risk increasing with polyp size. Adenocarcinoma occurs in ∼0.7% of laparoscopic cholecystectomies, though multiple factors elevate malignancy risk. Aim To determine the incidence of incidental neoplasia (intracholcystic papillary neoplasms (ICPN) and adenocarcinoma) in GBPs following laparoscopic cholecystectomy. Method: A 5-year retrospective analysis (2017–2021) of gallbladder histology was conducted. Cases with pre-operative hepatobiliary malignancies, benign inflammation, or dysplasia were excluded. Data included demographics, clinical/operative management, follow-up, and histopathology. Results Among 19 patients (11 female, 8 males; 14 aged <60 years, 5 ≥60 years), 17 underwent cholecystectomy primarily for GBP. Polyp characteristics: 10 single, 9 multiple. Imaging included ultrasound (n=18), CTAP (n=1), MRCP (n=5), and MRI liver (n=3). Polyp sizes: <5 mm (n=1), 6–9 mm (n=3), ≥10 mm (n=15). No primary sclerosing cholangitis or cirrhosis was observed; 4 cases had gallstones. Histopathology revealed 17 benign polyps, 1 ICPN, and 1 adenocarcinoma. Conclusions Malignancy was identified in 1 patient (5.3%) despite risk factors (age ≥60 years, polyp size/number, and gallstones). This underscores the low but present risk of incidental neoplasia in GBPs post-cholecystectomy, warranting selective surveillance.