Gallbladder diseases demonstrate a wide pathological spectrum ranging from chronic inflammatory changes to premalignant and malignant conditions. The spectrum of ailments that afflict the Gall bladder can be inflammatory, congenital and neoplastic in nature (1,2). With laparoscopic cholecystectomy being widely employed for symptomatic and asymptomatic gallestone disease, routine histopathological examination has become vital for early detection of unexpected lesions. Recent randomized controlled trials, such as by Mohan et al.,(3) have emphasized the natural history of asymptomatic gallstone disease and the limited symptomatic improvement following prophylactic cholecystectomy. Even in instances where it is detected early, Gall bladder Carcinoma boasts a forbidding mortality rate (4,6,7). Their findings highlight that atypical abdominal complaints often persist irrespective of surgical intervention and that gallbladder carcinoma, though rare, remains a significant concern in high-incidence regions.

This retrospective descriptive study examined 210 cholecystectomy specimens received over 11 months. Standard protocols for gross and histopathological evaluation were followed. Data were compared with contemporary clinical evidence, including randomized evaluations of asymptomatic gallstone disease, to contextualize the significance of routine histopathology in modern clinical practice. Notably a gall bladder carcinoma often occurs in patients with a history of symptomatic Gall stone disease, but it can also develop in those with asymptomatic gall stone disease (5).

Table 1 summarizes the distribution of histopathological findings in the present study. Histopathological Diagnosis Cases (n) Percentage (%) Chronic calculus cholecystitis 170 80.9 Chronic acalculous cholecystitis 24 11.4 Xanthogranulomatous cholecystitis 12 5.7 Adenocarcinoma, small-duct type 4 1.9 Total 210 100 Detailed Findings Chronic calculus cholecystitis constituted the majority of cases. Microscopically, chronic inflammation, mucosal ulceration, fibrosis, and Rokitansky–Aschoff sinus formation were noted. Chronic acalculous cholecystitis demonstrated similar features without calculi. Xanthogranulomatous cholecystitis (5.7%) exhibited lipid-laden macrophages, giant cells, and dense fibrosis. Four cases of small-duct type adenocarcinoma showed irregular infiltrative glands with stromal desmoplasia.

The findings of this study align with global trends where chronic calculus cholecystitis remains the predominant gallbladder pathology. Integration with recent evidence demonstrates that while asymptomatic gallstone disease may not significantly benefit from prophylactic cholecystectomy in terms of symptom resolution, the potential for incidental malignancy necessitates routine histopathological evaluation. Mohan et al.(3) reported that atypical abdominal symptoms often persist irrespective of surgical intervention, and no improvement was observed over a one-year follow-up. Although no carcinoma cases were encountered in their trial, the present study identified four incidental adenocarcinomas, reinforcing the critical role of histopathology. Small cell Carcinomas of Gall bladder is extremely rare, comprising only 0.5% of all stages or advanced stage showing a bad prognosis revealing it’s high malignant potential (8). Further Xanthogranulomatous Gall bladder’s clinical resemblance to carcinoma highlights the importance of microscopic differentiation (9). The combined interpretation suggests that while surgery may not alleviate vague symptoms in asymptomatic patients, it remains essential for definitive diagnosis and exclusion of malignancy. In this study, female predominance is observed in contrary a study was conducted by Mustaq revealed male:female of 1:2.4 (10,11). Despite the advent of modern Despite the advent of modern diagnostic techniques, GBC is still diagnosed at a late stage and is thus associated with a poor prognosis (12). Fig. 1,2,3 (1) H&E 40x Adenocarcinoma gall bladder , (2) H&E 10x Xanthogranulomatous changes of Gall bladder, (3) Rokitansky Aschoff sinuses in Chronic Cholecystitis 10x.

The integration of institutional data with contemporary clinical evidence confirms that chronic inflammatory lesions constitute the majority of gallbladder pathology. However, incidental detection of carcinoma emphasizes the necessity for routine histopathology. While recent trials show limited symptomatic benefit of prophylactic cholecystectomy, the potential risk of underlying neoplasia mandates thorough pathological evaluation in all cholecystectomy specimens. This study also aims to evaluate the impact of laproscopic cholecystectomy in preventing Carcinoma Gall bladder in North India.

1. Gupta K, Faiz A, Thakral RK, Mohan A, Sharma VK: The spectrum of histopathological lesions in gallbladder in cholecystectomy specimens. Int J Clin Diagnostic Pathol. 2019, 2:146-151. 10.33545/pathol.2019.v2.i1c.22 2. Singh A, Singh G, Kaur K, Goyal G, Saini G, Sharma D: Histopathological changes in gallbladder mucosa associated with cholelithiasis: a prospective study. Niger J Surg. 2019, 25:21-25. 10.4103/njs.NJS_15_18 3. DOI:http://doi.org/10.18203/23492902.isj20242450. Mohan A etal.Int Surg.J.2024Sep;11(9):1506-1509 4. Mondal B, Maulik D, Biswas B, Sarkar G, Ghosh D: Histopathological spectrum of gallstone disease from cholecystectomy specimen in rural areas of West Bengal, India: an approach of association between gallstone disease and gallbladder carcinoma. Int J Community Med Public Heal. 2016, 3:3229-3235. 10.18203/2394-6040.ijcmph20163941 5. Dutta V,BushN,Kalsi D, Popli P, Kapoor VK.Epidemiology of gall bladder Cancer in India. Chin Clin Oncol.2019;8(4):33 6. Chen C, Geng Z, Shen H, et al.: Long-term outcomes and prognostic factors in advanced gallbladder cancer: focus on the advanced T stage. PLoS One. 2016, 11:e0166361. 10.1371/journal.pone.0166361 7. Kafle SU, Sinha AK, Pandey SR: Histomorphology spectrum of gall bladder pathology in cholecystectomy specimens with clinical diagnosis of chronic cholecystitis. J Nepal Med Assoc. 2013, 52:600-607. 8. Rammohan A, Cherukuri SD, Sathyanesan J, Palaniappan R, Govindan M: Xanthogranulomatous cholecystitis masquerading as gallbladder cancer: Can it be diagnosed preoperatively?. Gastroenterol Res Pract. 2014, 2014:253645. 10.1155/2014/253645 9. Kishore R, Nundy S, Mehrotra S, Metha N, Mangla V, Lalwani S: Strategies for differentiating gallbladder carcinoma from xanthogranulomatous cholecystitis—a tertiary care centre experience. Indian J Surg Oncol. 2017, 8:554-559. 10.1007/s13193-017-0677-7 10. Mushtaq M, Sharma T, Sharma K, Mehta KS: Histopathological spectrum of gall bladder diseases after laparoscopic cholecystectomy: a retrospective study. Int J App Basic Med Res. 2017, 7:414-419. 11. Kotasthane VD, Kotasthane DS: Histopathological spectrum of gall bladder diseases in cholecystectomy specimens at a rural tertiary hospital of Purvanchal in North India-does it differ from South India? . Arch Cytol Histopathol Res. 2020, 5:91-95. 10.18231/j.achr.2020.018 12. Beena D, Shetty J, Jose V: Histopathological spectrum of diseases in gallbladder . Natl J Lab Med. 2017, 6:6-9.