Risk factors for malignant change in an asymptomatic patient with a gall bladder polyp on ultrasound include all of the following, except
|A||Age > 60 yrs|
|B||Rapid increase in size of polyp|
|C||Size of poplyp > 5 mm|
|D||Associated gall stones|
a. Approximately 90% of patients with carcinoma of the gallbladder have gallstones. However, the 20-year risk of developing cancer for patients with gallstones is less than 0.5% for the overall population and 1.5% for high-risk groups.
b. Polypoid lesions of the gallbladder are associated with increased risk of cancer, particularly in polyps larger than 10 mm. 66 The calcified "porcelain" gallbladder is associated with more than a 20% incidence of gallbladder carcinoma.
c. These gallbladders should be removed, even if the patients are asymptomatic. Patients with choledochal cysts have an increased risk of developing cancer anywhere in the biliary tree, but the incidence is highest in the gallbladder.
d. Sclerosing cholangitis, anomalous pancreaticobiliary duct junction, and exposure to carcinogens (azotoluene, nitrosamines) also are associated with cancer of the gallbladder.