Are histological alterations observed in the gallbladder precancerous lesions?
BACKGROUND
Gallbladder cancer, which is characterized by rapid progression and a poor prognosis, is a complex disease to treat. Unfortunately, little is known currently about its etiology or pathogenesis. A better understanding of its carcinogenesis and determining risk factors that lead to its development could help improve the available treatment options.


METHODS
Based on this better understanding, the histological alterations (such as acute cholecystitis, adenomyomatosis, xanthogranulomatous cholecystitis, polyps, pyloric metaplasia, intestinal metaplasia, dysplasia, cancer and others) in gallbladders from 1,689 patients who underwent laparoscopic cholecystectomy for cholecystolithiasis were analyzed. The association of these gallbladder histological alterations with clinical data was studied.


RESULTS
Gender analysis revealed a greater incidence of inflammatory changes in males, while dysplasia and cancer were only found in women. The incidence of cholesterolosis was greater in the patients 60 years of age and under, and the incidence of adenomyomatosis and gangrene was greater in the elderly patients. A progressive increase in the average age was observed as alterations progressed through pyloric metaplasia, intestinal metaplasia, dysplasia and then cancer, suggesting that the metaplasia-dysplasia-carcinoma sequence may occur in gallbladder cancer. Gallbladder histological alterations were also observed in asymptomatic patients.


CONCLUSIONS
The results of this study suggest that there could be an association between some histological alterations of gallbladder and cancer, and they also suggest that the metaplasia-dysplasia-carcinoma sequence could in fact be true in the case of gallbladder cancer. Nevertheless, further studies directed towards a perfect understanding of gallbladder carcinogenesis are required.
Meirelles-Costa
Adriana Lúcia Agnelli
AL
Department of Gastroenterology, Gastrointestinal Surgery Unit, Laparoscopic Surgery Unit, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. adriana.agnelli@uol.com.br
Bresciani
Claudio José Caldas
CJ
Perez
Rodrigo Oliva
RO
Bresciani
Barbara Helou
BH
Siqueira
Sheila Aparecida C
SA
Cecconello
Ivan
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017081:Cholecystectomy, Laparoscopic; D018450:Disease Progression; D005260:Female; D005704:Gallbladder / Q000473:pathology*; D005705:Gallbladder Diseases / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult