膽息肉的處理

CLASSIFICATION — The classification of gallbladder polyps was first proposed in 1970 based upon a review of 180 benign tumors. As a general rule, polypoid lesions can be divided as benign or malignant. 　Benign lesions are further subdivided into neoplastic or non-neoplastic. The most common benign neoplastic lesion is an adenoma. Benign mesodermal tumors such as leiomyomas and lipomas are rare. The most common benign non-neoplastic (pseudotumors) are cholesterol polyps (the presence of which is referred to as "cholesterolosis"), followed by adenomyomas (the presence of which is referred to as "adenomyomatosis"), and inflammatory polyps. Cholesterolosis and adenomyomatosis are mucosal abnormalities of the gallbladder. They have been referred to as "hyperplastic cholecystoses," a term introduced in 1960 to differentiate them from inflammatory conditions such as acute cholecystitis since they lack inflammatory features but exhibit features of hyperplasia. The most common malignant lesion in the gallbladder is adenocarcinoma. Gallbladder adenocarcinomas are much more common than gallbladder adenomas in contrast to the colon where adenomas are much more common than adenocarcinomas. Squamous cell carcinomas, mucinous cystadenomas, and adenoacanthomas of the gallbladder are rare.

CHOLESTEROLOSIS AND CHOLESTEROL POLYPS — Cholesterolosis is characterized by the accumulation of lipids in the mucosa of the gallbladder wall. It is a benign condition that is usually diagnosed incidentally during cholecystectomy or on ultrasonography. However, in some patients it can lead to symptoms and complications similar to those caused by gallstones.

DIAGNOSIS — Advances in diagnostic imaging have resulted in improved sensitivity for the detection of gallbladder polyps. Although none of the available modalities can reliably and unequivocally predict the type, histology, or the presence of malignancy, a combination of features seen on ultrasound, CT scan, and endoscopic ultrasonography (EUS) can provide valuable information.

Ultrasonography — Polyps are easily identified on ultrasonography as single or multiple echogenic foci that can be easily differentiated from gallstones because they are fixed. They do not move when the patient is rolled from one side to another and they do not cast a shadow. As noted above, the most useful predictive feature for malignancy is the size of the polyp. Polyps larger than 2 cm are almost always malignant and in many cases the cancer is advanced. Polyps of 1 to 2 cm in size should be regarded as possibly malignant. As mentioned above, several pathologic studies support this with the incidence of carcinoma being 43 to 77 percent in polyps larger than 1 cm and 100 percent in polyps larger than 2 cm. Cholesterol polyps are usually smaller than 1 cm.

In addition to size and number, ultrasonography can delineate other useful distinguishing characteristics in the appearance of polyps. These may include echogenicity, surface architecture, and the presence of a pedicle. Cholesterol polyps are usually multiple, homogeneous, and pedunculated polypoid lesions that are more echogenic than the liver parenchyma. They may or may not contain hyperechoic spots and have a mulberry-like surface.

TREATMENT — Lesions smaller than 5 mm — Polyps smaller than 5 mm are usually benign and most frequently represent cholesterolosis. Asymptomatic patients with cholesterol polyps do not need treatment. However, a repeat ultrasound examination in 6 and 12 months may be appropriate. Follow-up examination are not necessary if the polyp is stable. Medical management aimed at increasing the solubility of cholesterol in bile by administering ursodeoxycholic acid is without benefit in patients with cholesterolosis.

So yours is a benign cholesterol polyp not likely causing symptoms. No and no need for treatment. I advise ignore but you may repeat USG in one year.