Is it Necessary to Submit Grossly Normal Looking Gall Bladder Specimens for Histopathological Examination?

Background: The objectives of the study were to: 1) determine the frequency of incidental malignancy inunsuspected/grossly normal looking gall bladders; 2) determine the frequency of malignancy in suspected/grosslyabnormal looking gall bladders. Materials and
Methods: This prospective, cross sectional study was carried outat a tertiary care hospital in Pakistan, during a four year period (Jan 2009-dec2012). All the cholecystectomycases performed for gallstone diseases were examined initially by a surgeon and later on by a pathologist formacroscopic abnormalities and accordingly assigned to one of the three categories i.e. grossly normal, suspicious,abnormal/malignant. Frequency of incidental carcinoma in these categories was observed after receiving the finalhistopathology report.
Results: A total of 426 patients underwent cholecystectomy for cholelithiasis, with a 1:4male: female ratio. Mean age of the patients was 45 years with a range of 17-80 years. The frequency of incidentalgallbladder carcinoma was found to be 0.70 %(n=3). All the cases of gallbladder carcinoma were associatedwith some macroscopic abnormality. Not a single case of incidental carcinoma gallbladder was diagnosed in383 ‘macroscopically normal looking’ gallbladders.
Conclusions: Incidental finding of gall bladder cancer wasnot observed in any of macroscopically normal looking gall bladders and all the cases reported as carcinomagallbladder had some gross abnormality that made them suspicious. We suggest histopathologic examinationof only those gall bladders with some gross abnormality.