Histopathological re-evaluation of the cholecystectomy materials at our archive

PurposeBile stones are seen among 10 ? 20 % of the world population with an increasing frequency by age and female gender. This disease is one of the most frequent medical problems that require surgical intervention. Particularly, the incidence of bile stones reaches to an epidemic extent among the Indian population in North and South America. Bile stones are found in 65 ? 90 % of gallbladder carcinoma which is at the fifth rank among the most frequently seen gastrointestinal carcinomas. While one study reports that gallbladder carcinomas are found most frequently among the inhabitants of North and South America, Poland, and North India, another study finds the highest incidence of gallbladder cancer in India, Pakistan, and Ecuador.In the light of above explanation, it is certain that the incidence of the diseases related to the gallbladder, either benign or malign, depends on geographical and social differences. On the other hand, there are very few studies on this subject in Turkey. Given these facts, the present study aims to determine the profile of the gallbladder diseases in Afyonkarahisar region, making histopathological re-evaluation on all cholecystectomy materials collected at our hospital over 8 years and discussing them in the light of the related literature.Materials and methodsIn doing so, we carried out a study on the archive at the Faculty of Medicine Hospital, Afyon Kocatepe University, Turkey, for the period of January 2000 ? April 2008 to determine all cholecystectomy cases, including those due to cholelithiasis, acute cholecystitis, polyp, malignancy, etc. At the end, a total of 1500 cases were determined. By taking new sections and painting them with hematoxylin & eozin when necessary, the samples of cholecystectomy materials were re-evaluated regarding following points: state of epithelium, inflammation, cholesterolysis, atrophy, hyperplasia, masoplasia, polyp, adenoma, dysplasia, carcinoma in situ, carcinoma, carcinoma type and degree, lenfovascular and perineural invasion of carcinoma. In addition, by examining pathology reports of these cases and depending on macroscopic descriptions, the following variables are determined: age and gender of the patients, form of surgery, thickness of gallbladder wall, and availability, number, and type of bile stones.ResultsDepending on the reports and histopathological re-evaluation, the findings of the study regarding the total of 1500 cases are as follows: Firstly, while 1049 (69.9 %) of the patients are female, 451 (30.1) of them are male, at different ages between 13 and 97, average of which is 52.9. Secondly, distribution of these cases is as follows: 14 (0.93) are primary gallbladder carcinoma, 4 (0.3 %) are carcinoma in situ, 2 (0.1 %) are adenoma (2 are pyloric gland adenoma), 24 (1.6 %) are dysplasia (20 are mild dysplasia, 4 severe dysplasia), 37 (2.5 %) are polyp (22 are cholesterol polyp, 8 adenomyoma, 4 hyperplastic polyp, and 3 inflammatory polyp), 174 (11.6) are metaplasia (113 pyloric metaplasia, 25 pyloric metaplasia and hyperplasia, 15 intestinal metaplasia, 12 pyloric metaplasia and intestinal metaplasia, 5 pyloric metaplasia and atrophy, 2 intestinal metaplasia and hyperplasia, 2 pyloric metaplasia and intestinal metaplasia and hyperplasia), 47 (3 %) are hyperplasia, 2 (0.1 %) are atrophy, 200 (13.3 %) are cholesterolysis, 1473 (98.2) are cholecystitis (1338 are chronic cholecystitis, 91 are acute cholecystitis, 25 active chronic cholecystitis, 6 eosinophilic cholecystitis, 6 ksantogranulmatoz cholecystitis, 7 follicular cholecystitis), and 1344 (89.6 %) are gallbladders with bile stones.ConclusionThirdly, there are statistically significant relationships between cholesterolysis and gender (P < 0.001), between cholesterolysis and bile stones (P < 0.001), between polyp and cholecystitis (P < 0.05), between metaplasia and bile stones (P < 0.05), between hyperplasia and cholesterolysis (P < 0.001) as well as between dysplasia and metaplasia (P < 0.001). Fourthly, the rate of bile stones presence in carcinomas, the rate of pyloric metaplasia and intestinal metaplasia presence, the rate of polyp presence, the rates of pyloric and intestinal metaplasia presence in dysplasia cases, and the rate of eosinophilic cholecystitis presence are found as being less than those in the literature. Finally, there is no statistically significant relationship between epithelium degeneration and the surgery form as being either open cholecystectomy or laparoscopic cholecystectomy.The above given findings are in parallel with those found in the western countries with some minor differences. It can be said that the low rates regarding the metaplasic changes may increase if more samples are included as stated in the literature. However, it may also be considered as a regional difference.