A retrospective review of histopathological findings after cholecystectomy in a single center in Palestine

Background and study aim: Traditionally, gallbladders removed due to suspected benign disease are sent for histopathological examination, though this practice remains a topic of debate. This study aims to review the pathology findings of routinely examined gallbladder specimens, determine the incidence of incidental gallbladder carcinoma in our population, and evaluate the importance of routine histological analysis of resected gallbladders. Patients and Methods: The histopathological reports of 2371 patients who underwent cholecystectomy from January 2012 to November 2022 in Palestine were retrospectively reviewed. Results: 582 were males (24.5%) and 1789 were females (75.5%). The mean age was 46.3 years. Laparoscopic cholecystectomy was the mode of surgical removal in 84.6% of cases, while 12.6 % of cases required open surgery for removal of the gallbladder. Histological examination of the surgical specimens showed chronic cholecystitis (n = 1956) (82.5%), acute on top of chronic cholecystitis (n=348) (14.7%), cholesterolosis (n=45) (1.9%), adenocarcinoma (n=2) (<0.1%) who were both females with mean age of 60 years, xanthogranulomatous cholecystitis (n = 3) (0.1%), intestinal metaplasia (n = 8) (0.3%), chronic cholecystitis with focal epithelial dysplasia (n = 5) (0.2%), porcelain calcification (n = 2) (0.1%). One case showed hyalinizing cholecystitis. Conclusions: Our study demonstrates that the incidence of pre-malignant and malignant lesions of the gallbladder in the resected specimens is very low. Given this low incidence, routine histopathological examination of cholecystectomy specimens may not always be necessary without clinical suspicion. We recommend establishing a more focused or selective approach, which considers histopathology on a case-by-case basis, depending on specific clinical or radiological indicators.