American Journal of Medicine and Medical Sciences

p-ISSN: 2165-901X    e-ISSN: 2165-9036

2021;  11(1): 33-35

doi:10.5923/j.ajmms.20211101.08

Received: Dec. 13, 2020; Accepted: Dec. 30, 2020; Published: Jan. 15, 2021

 

The Role of Benign Polyps in the Formation of a Precancerous State of the Gallbladder

Egamberdiyev Kuvonchbek1, Nizom Ermatov2, Khaitov Akbar1

1Assistants, Department of General Surgery and Orthopedics Traumatology of the Urgench Branch of Tashkent Medical Academy, Khorezm, Uzbekistan

2Head of the Department of Hygiene of Children and Adolescents and Food Hygiene of the Tashkent Medical Academy, Tashkent, Uzbekistan

Copyright © 2021 The Author(s). Published by Scientific & Academic Publishing.

This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstract

According to autopsy studies, gallbladder cancer is the most common malignant neoplasm of the biliary tract, accounting for 80–95% of all biliary cancer cases worldwide. Purpose of the study. Determine the role of benign polyps in the formation of a precancerous state of the gallbladder. Materials and research methods. To achieve this goal, the results of treatment of 45 patients with precancerous diseases of the gallbladder were analyzed. Depending on the cause of the etiological factor that caused the precancerous state of the gallbladder, all patients were divided into 2 groups: group 1 - patients who found stones in the gallbladder on ultrasound examination (n = 26), moreover, patients who had stones up to 3 cm was 17 people, and patients who, according to ultrasound, found stones more than 3 cm (n = 9), group 2 - patients who, according to microbiological studies, had a history of infectious processes (n = 19), and patients who, according to microbiological researches were identified as the causative agent of Hellicobacter billis - 11 patients, and 8 patients had chronic typhoid infection as an etiological factor. Research results. Among all examined (n = 45), divided by gender, 23 patients were men, 22 were women. Gallstones were more common in men than in women (14 vs 12). Biliary polyps were found in all examined patients (100%). The average age at the time of the examination was 49.3 ± 12.0 years. Among the examined patients, 2 (4.45%) had gallbladder hamartoma as an etiological factor, and 1 (2.23%) had mixed infection. 4 (8.89%) patients had a gallbladder adenoma, i.e. her hyperplasia. In the quality of heterotopia, pathology of the liver and gallbladder was found in 3 (6.67%). The following drugs can be used as adjuvant therapy after surgical treatment: gemcitabines, fluoropyrimidines. Monotherapy has a limited effect. The combination of chemotherapy with gemcitabines and cisplastins gives better survival than simple gemcitabine administration (p≤0.05, U-0.03467, r = 0.116528, χ2 = 0.87514). Conclusions: According to the conducted studies, as an etiological factor, the increased content of the triglyceride fraction was higher in patients with a body mass index of 24.32 ± 3.54 with a confidence interval of 95% (p≤0.05, U-0.07833), which indicates violation of fat metabolism and lipolysis in the liver, as a result of which the synthesis of apoliprotein E is disrupted, which leads to the accumulation of high-density lipoproteins and the possible formation of gallbladder polyps, as a possible harbinger of precancerous conditions of the gallbladder.

Keywords: Precancerous diseases of the gallbladder, Benign polyps, Fraction of triglycerides, Ultrasound procedure, Microbiological examination

Cite this paper: Egamberdiyev Kuvonchbek, Nizom Ermatov, Khaitov Akbar, The Role of Benign Polyps in the Formation of a Precancerous State of the Gallbladder, American Journal of Medicine and Medical Sciences, Vol. 11 No. 1, 2021, pp. 33-35. doi: 10.5923/j.ajmms.20211101.08.

Article Outline

1. Introduction
2. Purpose of the Research
3. Materials and Methods
4. Results
5. Conclusions

1. Introduction

According to autopsy studies, gallbladder cancer is the most common malignant neoplasm of the biliary tract, accounting for 80–95% of all biliary cancer cases worldwide [6]. It ranks sixth among gastrointestinal cancers. However, global rates of gallbladder cancer show striking variability, reaching epidemic levels for some regions and ethnic groups. The basis for this variation is likely to lie in differences in environmental exposure and intrinsic genetic predisposition to carcinogenesis [15]. These risk factors differ geographically and among ethnic groups. In most cases, gallbladder cancer develops within 5–15 years, when metaplasia develops into dysplasia, carcinoma in situ, and then into invasive cancer [19]. Progression often happens quickly and imperceptibly, which portends a bleak prognosis. A satisfactory outcome depends on early diagnosis and surgical resection [2]. Despite this potential for cure, less than 10% of patients have tumors that need to be resected during surgery, while almost 50% have lymph node metastases [8]. Even after surgery, most patients progress to metastases, highlighting the importance of improving adjuvant therapy. Lesions that protrude from the wall of the gallbladder into the interior of the gallbladder are called gallbladder polyps (GP) [11]. In most patients, the diagnosis is made incidentally by routine abdominal ultrasound or after cholecystectomy for gallstones or biliary colic. Although most gallbladder polyps are benign in nature, malignant polyps are present in some cases, and early detection and proper early assessment are important for treatment and long-term survival [1,3,4,5,7,9,10,12,13,14]. The main goal of treatment for gallbladder polyps is to prevent the development of gallbladder carcinoma.
The term "polypoid lesions of the gallbladder" refers to a wide range of findings. Gallbladder polyps are classified as either benign or malignant. Benign prostatic veins are subdivided into pseudotumors (cholesterol polyps, inflammatory polyps; cholesterolosis and hyperplasia), epithelial tumors (adenomas), and mesenchymal tumors (fibroma, lipoma, and hemangioma). Malignant prostatic gallstones are carcinomas of the gallbladder. A poor prognosis for patients with gallbladder carcinoma means that it is important to distinguish between benign polyps and malignant or precancerous polyps [16].
The prevalence of gallbladder polyps was 4.3–6.9%. Polypoid lesions of the gallbladder include many pathological types. [20] Although there are some differences reported, the prevalence of polypoid lesions of the gallbladder is reported in 2–12% of cholecystectomy specimens, which probably depends on the indication for cholecystectomy [17,18].

2. Purpose of the Research

Determine the role of benign polyps in the formation of a precancerous state of the gallbladder.

3. Materials and Methods

To achieve this goal, the results of treatment of 45 patients with precancerous diseases of the gallbladder were analyzed. Depending on the cause of the etiological factor that caused the precancerous state of the gallbladder, all patients were divided into 2 groups: group 1 - patients who found stones in the gallbladder on ultrasound examination (n = 26), moreover, patients who had stones up to 3 cm was 17 people, and patients who, according to ultrasound, found stones more than 3 cm (n = 9), group 2 - patients who, according to microbiological studies, had a history of infectious processes (n = 19), and patients who, according to microbiological researches were identified as the causative agent of Hellicobacter billis - 11 patients, and 8 patients had chronic typhoid infection as an etiological factor.
All patients signed a voluntary written consent to participate in the experiment. Statistical processing of the results was carried out using the Student-Fischer, Kraskes-Wallis test, the nonparametric Mann-Winney test, and the Wilconson test for indirect samples.

4. Results

Among all examined (n = 45), divided by gender, 23 patients were men, 22 were women. Gallstones were more common in men than in women (14 vs 12). Biliary polyps were found in all examined patients (100%). The average age at the time of the survey was 49.3 ± 12.0 years.
Table 1. The main indicators of the examined patients
     
Figure 1. Survival of patients with precancerous conditions of the gallbladder
Figure 2. Distribution of patients depending on the stage of the tumor
Among the examined patients, 2 (4.45%) had gallbladder hamartoma as an etiological factor, and 1 (2.23%) had mixed infection.
4 (8.89%) patients had a gallbladder adenoma, hyperplasia. As a heterotopia, pathology of the liver and gallbladder was found in 3 (6.67%).
The following drugs can be used as adjuvant therapy after surgical treatment: gemcitabines, fluoropyrimidines. Monotherapy has a limited effect. The combination of chemotherapy with gemcitabines and cisplastins provides better survival than simple gemcitabine administration (p≤0.05, U-0.03467, r = 0.116528, χ2 = 0.87514).
Mann-Winney U test
r- Spearman's rank test
Wilconson χ test for indirect samples
p-standard deviation

5. Conclusions

According to the conducted studies, as an etiological factor, the increased content of the triglyceride fraction was higher in patients with a body mass index of 24.32 ± 3.54 with a confidence interval of 95% (p≤0.05, U-0.07833) which indicates metabolic disorders fat and lipolysis in the liver, as a result of which the synthesis of apoliprotein E is disrupted, which leads to the accumulation of high density lipoproteins and the possible formation of gallbladder polyps, as a possible harbinger of precancerous conditions of the gallbladder.

References

[1]  Albores-Saavedra J, Klöppel G, et al. Carcinoma of the gallbladder and extrahepatic bile ducts. In: Bosman FT, Carneiro F, Hruban RH, et al., editors. World Health Organization Classification of Tumours of the Digestive System. 4th ed. WHO Press; Geneva: 2010. pp. 263–278.
[2]  Azuma T, Yoshikawa T, et al. Differential diagnosis of polypoid lesions of gallbladder by endoscopic ultrasonography. Am J Surg. 2001; 181: 65–70.
[3]  A. Vulcan, J. Brändstedt, J. Manjer, K. Jirström, B. Ohlsson, and U. Ericson, “Fibre intake and incident colorectal cancer depending on fibre source, sex, tumour location and tumour, node, metastasis stage,” British Journal of Nutrition, vol. 114, no. 6, pp. 959–969, 2015.
[4]  A. M. Bernstein, M. Song, X. Zhang et al., “Processed and unprocessed red meat and risk of colorectal cancer: analysis by tumor location and modification by time,” PLoS One, vol. 10, no. 8, article e0135959, 2015.
[5]  Bang S. Natural course and treatment strategy of gallbladder polyp. Korean J Gastroenterol 2009; 53: 336-40.
[6]  Buckles DC, Lindor KD, Larusso NF, Petrovic LM, Gores GJ. In primary sclerosing cholangitis, gallbladder polyps are frequently malignant. Am J Gastroenterol 2002; 97: 1138-42.
[7]  Cantürk Z, Sentürk O, Cantürk NZ, Anik YA. Prevalence and risk factors for gall bladder polyps. East Afr Med J 2007; 84: 336-41.
[8]  Choi JH, Yun JW, Kim YS, Lee EA, Hwang ST, Cho YK, et al. Pre-operative predictive factors for gallbladder cholesterol polyps using conventional diagnostic imaging. World J Gastroenterol 2008; 14: 6831-4.
[9]  Damore LJ 2nd, Cook CH, Fernandez KL, Cunningham J, Ellison EC, Melvin WS. Ultrasonography incorrectly diagnoses gallbladder polyps. Surg Laparosc Endosc Percutan Tech 2001; 11: 88-91.
[10]  Elmasry M, Lindop D, et al. The risk of malignancy in ultrasound detected gallbladder polyps: A systematic review. Int J Surg. 2016; 33: 28–35.
[11]  Еuropean Association for the Stud. EASL Clinical Practice Guidelines: Management of cholestatic liver diseases. Journal of Hepatology. August 2009; 51(2): 237–267.
[12]  Gonzalez-Escobedo G, Marshall JM. Chronic and acute infection of the gall bladder by Salmonella Typhi: understanding the carrier state. Nature Reviews: Microbiology. January 2011; 9(1): 9–14.
[13]  Gupta P, Agarwal A, Gupta V, Singh PK, Pantola C, Amit S. Expression and clinicopathological significance of estrogen and progesterone receptors in gallbladder cancer. Gastrointest Cancer Res. 2012; 5(2): 41–47.
[14]  Hattori M, Inui K, Yoshino J, Miyoshi H, Okushima K, Nakamura Y, et al. Usefulness of contrast-enhanced ultrasonography in the differential diagnosis of polypoid gallbladder lesions. Nihon Shokakibyo Gakkai Zasshi 2007; 104: 790-8.
[15]  Kratzer W, Haenle MM, Voegtle A, Mason RA, Akinli AS, Hirschbuehl K, et al.; Roemerstein Study Group. Ultrasonographically detected gallbladder polyps: A reason for concern? A seven-year follow-up study. BMC Gastroenterol 2008; 8: 41.
[16]  Kianmanesh R, Scaringi S, Castel B, Flamant Y, Msika S. Precancerous lesions of the gallbladder. J Chir (Paris) 2007; 144: 278-86.
[17]  Kwon W, Jang JY, Lee SE, Hwang DW, Kim SW. Clinicopathologic features of polypoid lesions of the gallbladder and risk factors of gallbladder cancer. J Korean Med Sci 2009; 24: 481-7.
[18]  Lee JS, Lee KT, Jung JH, Ok SW, Choi SC, Lee KH, et al. Factors associated with malignancy in gallbladder polyps without gallbladder stone. Korean J Gastroenterol 2008; 52: 97-105.
[19]  Yang LP, Yang ZL, Tan XG, Miao XY. Expression of annexin A1 (ANXA1) and A2 (ANXA2) and its significance in benign and malignant lesions of gallbladder. Zhonghua Zhong Liu Za Zhi 2010; 32: 595-9.
[20]  Zielinski MD, Atwell TD, Davis PW, Kendrick ML, Que FG. Comparison of surgically resected polypoid lesions of the gallbladder to their pre-operative ultrasound characteristics. J Gastrointest Surg 2009; 13: 19-25.