Hyperplasia, metaplasia, dysplasia and neoplasia lesions in chronic cholecystitis - a morphologic study

The aim of the study was to analyze the association between chronic cholecystitis, premalignant lesions and gallbladder cancer. The group consisted in 3901 cases of cholecystectomies, diagnosed as acute cholecystitis (250 cases - 6.4%), chronic cholecystitis (3619 cases - 92.8%) and gallbladder carcinoma (32 cases - 0.8%). Chronic cholecystitis associated premalignant lesions as follows: hyperplasia in 124 cases (7.8%), metaplasia in 86 cases (5%) and dysplasia in 10 cases (0.4%). Only in nine cases, the diagnosis of gallbladder carcinoma was formulated presumptively, before surgery; for the other 23 cases this diagnosis was established after the pathologic exam on the cholecystectomy piece. In the areas adjacent to the neoplastic proliferation, premalignant lesions (hyperplasia, metaplasia, dysplasia) were identified in 34.4% cases. The identification of premalignant modifications in the morphologic background of chronic cholecystitis is an argument in favor of the metaplasia-dysplasia-neoplasia sequence and justifies recent recommendations for the performing of colecystectomy.