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RMJ. 2012; 37(2): 172-175

Microscopic assessment of macroscopically normal gall bladder specimens: Is it worth the trouble?

Madiha Sajjad, Rehan Ahmed Khan, Samina Iltaf.

Background: A large number of specimens are submitted to histopathology departments for microscopic examination where it is felt that this examination is inappropriately time consuming, costly, and contributes little if anything to the further management of the patients.
Objectives: To assess that the histologic examination of macroscopically normal looking gallbladder specimens is really needed.
Study Design: Descriptive study.
Setting: IIMCT-Railway General hospital, Rawalpindi.
Methods: All cholecystectomy specimens submitted to the department of histopathology at the Railway Hospital IIMCT, during a 5 years period from January 2006 to December 2010, were included in the study regardless of age and sex. The total number of blocks submitted was 400 (average 1.2 blocks/ specimen).
Specimen reports were retrieved by computer search. The clinical history provided on the specimen request form was recorded. The case notes were retrieved in cases of malignancy to evaluate preoperative ultrasound and intraoperative findings. Macroscopic findings by a consultant pathologist were recorded from the reports. The subsequent microscopic findings from these cases were reassessed to determine whether any lesions of clinical importance were identified.

Results: A total of 326 cases of gallbladder specimens were subjected to histopathological examination within the study period. Twenty seven percent ( n=88) were males and 73 %( n=238) were females with age range from 54 years to 80 years (average 62 years).
Chronic cholecystitis was the most common findings with about 84.7% of cases (n=276), followed by acute cholecystitis14.7% (n=48). Only two of the gall bladders showed adenocarcinoma (0.6%), which was preoperatively diagnosed on ultrasound findings and suspected on gross/macroscopic examination.

Conclusions: Microscopic assessment of macroscopically normal cholecystectomy specimens does not contribute to patient management and a more selective approach should be considered. This will reduce the burden on pathology departments, along with considerable cost containment.

Key words: Cholecystectomy, histopathology, gall bladder carcinoma.

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