Gallbladder Polyp of 5 cm found to have Carcinoma In Situ on Frozen Section Managed by Open Cholecystectomy Alone: A Case report

Background: Gallbladder polyps larger than 1 cm are considered to carry malignant potential and are commonly managed surgically. Lesions exceeding 2 cm are often presumed to represent invasive carcinoma, frequently prompting consideration of extended hepatic resection. However, carcinoma in situ confined to the mucosa within large gallbladder polyps is rarely reported. This case highlights a rare presentation of a giant gallbladder polyp harboring carcinoma in situ and emphasizes the role of intraoperative pathological assessment in guiding appropriate surgical management. Case presentation: A 50-year-old woman presented with postprandial right upper quadrant discomfort of several weeks’ duration. Abdominal ultrasound revealed a large gallbladder polyp, and subsequent magnetic resonance imaging demonstrated a 5 cm sessile polypoid lesion arising from the gallbladder fundus, without evidence of hepatic invasion or lymphadenopathy. Given the size and morphology of the lesion, an open cholecystectomy with intraoperative frozen section analysis was performed. Frozen section examination demonstrated carcinoma in situ confined to the mucosa, with no evidence of stromal or muscular invasion. Based on these findings, no additional hepatic resection or lymphadenectomy was undertaken. Final histopathological analysis confirmed a 5 cm tubulovillous adenoma with focal high-grade dysplasia consistent with carcinoma in situ, limited to the mucosa, with negative surgical margins. The patient had an uneventful postoperative recovery and was discharged in good condition. Conclusions: This case demonstrates that even large gallbladder polyps may harbor pre-invasive disease confined to the mucosa. Intraoperative frozen section analysis plays a critical role in determining the extent of surgery and may prevent unnecessary radical resections. Simple cholecystectomy alone can be curative for gallbladder carcinoma in situ when accurately diagnosed intraoperatively, reinforcing the importance of tailored surgical decision-making in the management of large gallbladder polyps.