Purpose of review: The increased risk of malignancy of the biliary tract and colon observed in primary sclerosing cholangitis raises concerns as to whether standard guidelines for the practical handling of polypoid lesions of the gallbladder apply to this group of patients. The present review aims to summarize existing knowledge on this topic.
Recent findings: Two recent studies reported adenocarcinoma in approximately 60% of the polypoid lesions of the gallbladder in patients with primary sclerosing cholangitis. One of the adenocarcinomas in the first of these studies, as well as two reported adenocarcinomas in a recent case series, occurred in lesions less than 1 cm. Cholecystectomy is normally not advocated for lesions less than 1 cm, but may be justified in patients with primary sclerosing cholangitis. In several studies, foci of dysplasia were also detected in separate adenomas and regions of the gallbladder not primarily affected by cancer. Concurrent dysplasia and malignancies of the bile ducts and colon have also been reported, and suggest that an increased awareness of malignancy is warranted in patients once gallbladder neoplasia has been detected.
Summary: The increased risk of malignancy in primary sclerosing cholangitis also applies to polypoid lesions of the gallbladder. Cholecystectomy and intensified screening for dysplasia of the bile ducts and colon may be advisable in primary sclerosing cholangitis patients with neoplasia of the gallbladder.