Asymptomatic gall stone disease: A clinicopathological correlation
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Department of Anatomy, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, India
Directorate of Medical Research, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, India
Submission date: 2017-08-17
Acceptance date: 2017-10-12
Online publication date: 2018-05-28
Publication date: 2019-11-18
Corresponding author
Pratima Baisakh   

Department of Anatomy, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University, K8, Kalinga Nagar, Bhubaneswar-751003, Odisha, India. Tel.: +91 9438844704.
Pol. Ann. Med. 2018;25(2):218-223
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.

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.

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.

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.

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.

Authors are grateful to Dean, IMS and SUM Hospital for extended facilities in this research work.
Baig SJ, Biswas S, Das S, Basu K, Chattopadhyay G. Histopathological changes in gallbladder mucosa in cholelithiasis: correlation with chemical composition of gallstones. Trop Gastroenterol. 2002;23(1):25–27.
Meyer G, Guizzardi F, Rodighiero S, et al. Ion transport across the gallbladder epithelium. Curr Drug Targets Immune Endocr Metabol Disord. 2005;5(2):143–151.
Aust S, Obrist P, Jaeger W, et al. Subcellular localization of the ABCG2 transporter in normal and malignant human gallbladder epithelium. Lab Invest. 2004;84(8):1024–1036.
Kuver R, Klinkspoor JH, Osborne WR, et al. Mucous granule exocytosis and CFTR expression in gallbladder epithelium. Glycobiology. 2000;10(2):149–157.
Afdhal NH, Smith BF. Choleterol crystal nucleation: A decade-long search for the missing link in gallbladder pathogenesis. Hepatology. 1990;11(4):669–702.
Goyal S, Singla S, Duhan A. Correlation between gallstones characteristics and gallbladder mucosal changes: A retrospective study of 313 patients. Clin Cancer Investig J. 2014;3(2):157–161.
Jacyna MR. Interactions between gallbladder bile and mucosa; Relevance to gallstone formation. Gut. 1990;31(5):568–570.
Kim HJ, Kim JS, Kim KO, et al. [Expression of MUC3, MUC5AC, MUC6 and epidermal growth factor receptor in gallbladder epithelium according to gallstone composition]. Korean J Gastroenterol. 2003;42(4):330–336 [in Korean].
Velanovich VF. Biliary dyskinesia and biliary crystals: a prospective study. Am Surg. 1997;63(1):69–73.
Lange K, Gottschalk M. [Gallbladder contractility in early stages of lithogenesis in the lithogenic fed guinea pig]. Z Gastroenterol; 1995;33(6):333–339 [in German].
Kouroumalis E, Hopwood D, Ross PE, Milne G, Bouchier IA. Gallbladder epithelial acid hydrolases in human cholecystitis. J Pathol. 1983;139(2):179–191.
Sood S, Kumar R, Varshney A, et al. A histopathological study of non-neoplastic gall bladder diseases with special reference to mucinhistochemistry. AABS. 2016;3(2):A189–A195.
Zaki M, Al-Refeidi A. Histological changes in the Human Gallbladder Epithelium associated with gallstones. OMJ. 2009;24(4):1–5.
Gupta SC, Misra V, Singh PA, Roy A, Misra SP, Gupta AK. Gall stones and carcinoma gall bladder. Indian J Pathol Microbiol. 2000;43(2):147–154.
Meirelles-Costa AL, Bresciani CJ, Perez RO, Bresciani BH, Siqueira SA, Cecconello I. Are histological alterations observed in the gallbladder precancerous lesions? Clinics (Sao Paulo). 2010;65(2):143–150.
Mohan H, Punia RP, Dhawan SB, Sekhon MS. Morphological spectrum of gallstone disease in 1100 cholecystectomies in North India. Indian J Surg. 2005;67(3):140–142.
Vahini G, Premalatha P, Mathi A, et al. A Clinicopathological Study of Gallbladder Lesions. IOSR-JDMS. 2015;14(2):15–20.
Sheth S, Bedford A, Chopra S. Primary gallbladder cancer: Recognition of risk factors and the role of prophylactic cholecystectomy. Am J Gastroenterol. 2000;95(6):1402–1410.
Satoh H, Koga A. Fine structure of cholesterolosis in the human gallbladder and the mechanism of lipid accumulation. Microsc Res Tech. 1997;39(1)14–21.<14::AID-JEMT2>3.0.CO;2-#.
Mukhopadhyay S, Landas SK. Putative Precursors of Gallbladder Dysplasia A Review of 400 Routinely Resected Specimens. Arch Pathol Lab Med. 2005;129(3):386–390.<386:PPOGDA>2.0.CO;2.
Behari A, Kapoor VK. Asymptomatic Gallstones (AsGS) – To Treat or Not to?. Indian J Surg. 2012;74(1):4–12.
Shukla HS, Avasthi K, Naithani YP. A clinicopathological study of the carcinoma of the gallbladder. Indian J Cancer. 1981;18:198–201.
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