Gallbladder benign tumors

　　In summary, the etiology of benign gallbladder tumors is not yet clear. Gallbladder polyps belong to papillary adenomas in pathology and can be divided into two types: cholesterol polyps and inflammatory polyps. The former is due to high gallbladder pressure or abnormal cholesterol metabolism, leading to the precipitation of cholesterol granules in the basal layer of mucosal epithelial cells, causing excessive expansion of tissue cells. Some scholars believe that it is due to macrophages on the mucosa phagocytizing cholesterol crystals and accumulating them. The latter is due to inflammatory stimulation causing adenomatous hyperplasia of the interstitial tissue, and it is formed by a large number of inflammatory cells, mainly lymphocytes and monocytes.

　　Gallbladder adenomyoma is one of the gallbladder proliferative lesions, caused by the hyperplasia and thickening of the gallbladder mucosa. The Rokitansky-Aschoff sinuses increase in number and expand into cystic structures, penetrating deep into the muscular layer, with channels connecting the sinus and the gallbladder lumen, forming pseudo-diverticula.

　　Patients with benign gallbladder tumors accompanied by gallstones may have symptoms of gallstones, and occasionally, partial detachment of papillary adenoma of the gallbladder can lead to obstructive jaundice. Clinically, it can manifest as steatorrhea, xanthelasma, hemorrhagic tendency, osteoporosis, and so on. It may also appear as yellowing of the skin, sclera, and urine, with an increased concentration of bilirubin in the blood, or without yellowing of the skin, sclera, and urine, with laboratory tests showing an increase in both bound and unbound bilirubin in the serum.

　　Patients with benign gallbladder tumors often have no specific clinical manifestations. The most common symptom is pain or discomfort in the upper right abdomen, which is generally not severe and can be tolerated. If the lesion is located at the neck of the gallbladder, it can affect the emptying of the gallbladder, often causing pain or colic in the upper right abdomen after meals, especially after a fatty meal. Other symptoms include indigestion, occasional nausea, and vomiting, all of which lack specificity. Some patients may be asymptomatic and are discovered during health checks or mass screenings.

　　To prevent benign gallbladder tumors, one should maintain a cheerful mental state, develop good eating habits, avoid spicy foods, eat less rich and greasy foods, and do not drink strong alcohol. For people over 40, especially women, regular ultrasound examination is recommended. If cholecystitis, gallstones, or polyps are found, further follow-up examination should be carried out. Early treatment should be sought if there are changes in the condition. Before actively treating the precancerous changes, it is important to eliminate potential carcinogenic factors, such as actively treating cholecystitis. For symptomatic gallstones or larger stones, early cholecystectomy should be performed.

　　Patients with benign gallbladder tumors can undergo ultrasound examination, X-ray cholecystography, and CT scan, as follows:

　　1, Ultrasound examination

　　B-ultrasound is the first choice for diagnosing gallbladder polypoid lesions, with advantages such as non-invasive, simple, economical, high detection rate of lesions, and easy popularization. The common characteristics of gallbladder polypoid lesions are echo masses that protrude into the gallbladder cavity, connected with the gallbladder wall, without shadow, and not moving with body position changes. Cholesterol polyps are often multiple, pedunculated, less than 10mm in size, and the longer the pedicle, the more it can swing inside the gallbladder. It is a non-uniform high-intensity echo mass without shadow and does not move with body position changes. Inflammatory polyps are nodular or papillary, mostly without pedicles, often less than 10mm in diameter, up to 30mm at most, with or without pedicles, showing low-intensity echo and without shadow; adenomyomatous hyperplasia can be seen as small rounded cystic images and scattered echo points protruding into the thickened gallbladder wall under B-ultrasound. The misdiagnosis rate or missed diagnosis rate of ultrasound examination is affected by gallstones inside the gallbladder, often resulting in the discovery of stones and the missed diagnosis of lesions, or the failure to detect the lesions due to their small size.

　　Endoscopic ultrasound examination (EUS) can clearly show the three layers of the gallbladder wall, from the inside out, showing the echo slightly higher mucosa and submucosa, the low echo muscle fiber layer, and the high echo serosal sublayer and serosa. It plays an important role in the differential diagnosis of cholesterolecithoma, adenoma, and gallbladder cancer. For cases that are difficult to diagnose with B-ultrasound, EUS examination is effective. Cholesterolecithoma is often a multiple, pedunculated, small, less than 10mm, and the longer the pedicle, the more it can swing inside the gallbladder. It is a non-uniform high-intensity echo mass without shadow and does not move with body position changes. Inflammatory polyps are nodular or papillary, mostly without pedicles, often less than 10mm in diameter, up to 30mm at most, with or without pedicles, showing low-intensity echo and without shadow. Adenomyomatous hyperplasia can be seen as small rounded cystic images and scattered echo points protruding into the thickened gallbladder wall under B-ultrasound. The misdiagnosis rate or missed diagnosis rate of ultrasound examination is affected by gallstones inside the gallbladder, often resulting in the discovery of stones and the missed diagnosis of lesions, or the failure to detect the lesions due to their small size.

　　2, X-ray cholecystography

　　X-ray cholecystography includes oral cholecystography, intravenous biliary tract cholangiography, and endoscopic retrograde cholangiography, which is a useful diagnostic method. The main imaging characteristics are varying sizes of filling defects. However, most reports believe that the detection rate and diagnostic coincidence rate of cholecystography are low, generally about 50% (27.3% to 53%), and the low detection rate is affected by poor gallbladder function, small lesions, or gallstones inside the gallbladder.

　　3, CT examination

　　The detection rate of CT for polypoid lesions of the gallbladder is lower than that of B-ultrasound, higher than that of cholecystography, with detection rates ranging from 40% to 80%. The imaging characteristics are similar to those of B-ultrasound imaging. If CT examination is performed under cholecystography conditions, the imaging is clearer.

　　4, Selective gallbladder artery angiography

　　According to the characteristics of feather-like hyperdensity on imaging, the stenosis or occlusion of arteries, it is possible to distinguish between tumor or non-tumor lesions. However, early gallbladder cancer and gallbladder adenomas may not have stenosis and occlusion images of the gallbladder artery, or both may have hyperdensity images of the tumor. The differentiation between the two is difficult.

　　In addition to general treatment, patients with benign gallbladder tumors should also pay attention to adjusting their diet.

　　1, You can eat foods that can promote bile secretion and relax the sphincter of the bile duct, such as hawthorn, black plum, and corn silk (infused water as tea).

　　2, Protect the function of the digestive system with beets, myrica, yam, coix seed, radish, and other foods.

　　3. Eat more foods that are beneficial for biliary drainage and anti-cancer, such as buckwheat, Job's tears, hedgehog mushrooms, dregs, mushrooms, sea cucumber, figs, sesame, sea buckthorn, etc.

　　4. Eat more grains, coarse grains, beans, and their products, fresh melons and fruits, vegetables, garlic, mushrooms, mushrooms, onions, fish, and other foods that have a lowering cholesterol effect.

　　5. Eat more fruits and vegetables rich in vitamin A, B vitamins, and vitamin C, such as oranges, apples, tomatoes, and other fruits and vegetables.

　　6. Controlling the amount of fat is the most important in the diet of patients with gallbladder diseases. Generally, about 20 grams of oil should be provided daily, but it should not be concentrated in one meal, and it should be roughly uniform in three meals. Because too much fat can easily cause colic, fried and fried food should be avoided, and it is best to use vegetable oil, which helps bile excretion and avoid animal fats such as lard.

　　7. Eat less or no cholesterol-rich food, such as: century egg, egg yolk, fish roe, animal liver, heart, kidney, stomach, and other internal organs, and fatty meat, etc. The amount of cholesterol provided in the daily diet should not exceed 300 milligrams.

　　8. Avoid smoking, alcohol, and spicy刺激性 food; avoid moldy, fried, smoked, and preserved food; avoid hard, sticky, and difficult-to-digest food.

　　For gallbladder benign tumors with a diameter less than 10mm and without obvious clinical symptoms, whether solitary or multiple, surgery can be temporarily postponed and regular ultrasound observation and follow-up can be performed. When the lesion shows significant enlargement, surgical treatment should be considered. There is no effective drug treatment for gallbladder benign tumors, and surgical resection of the gallbladder is the main treatment method.

　　First, surgical indications

　　1. The lesion is larger than 10mm;

　　2. Suspected to be malignant tumor, the lesion invades the muscular layer;

　　3. It is difficult to determine whether the lesion is benign or malignant;

　　4. The lesion increases rapidly after short-term observation;

　　5. The lesion is located in the gallbladder neck and affects the emptying of the gallbladder;

　　6. There are obvious clinical symptoms and complications such as gallstones or acute and chronic cholecystitis. All those with the above indications should undergo surgical treatment.

　　Second, the selection of surgical methods

　　Simple cholecystectomy is suitable for various benign gallbladder tumors. If benign gallbladder lesions develop into cancer and have invaded the muscular layer or even the serous layer, they should be treated as gallbladder cancer. During cholecystectomy, the gallbladder specimen should be anatomically examined, and routine frozen section pathological examination should be performed on suspicious lesions to detect early lesions.