Synopsis
Distinguish common benign polypoid findings from lesions needing surveillance or hepatopancreatobiliary review, and recognise incidental or symptomatic gallbladder cancer without disrupting oncological planning.
- Most small gallbladder polypoid lesions are benign cholesterol deposits, but size, sessile morphology, focal wall thickening, interval growth and patient risk factors influence malignancy concern.
- Ultrasound reports should document maximum diameter, attachment, mobility, acoustic shadowing, adjacent wall and comparison with prior imaging; stones move and shadow, whereas a true polyp remains attached.
- Do not memorise one universal operation or surveillance threshold: apply the current network radiology and HPB policy, because measurement variability and accepted algorithms can change.
Key red flags
Unexpected adenocarcinoma in a cholecystectomy specimen requires staging, pathology review and specialist MDT discussion before assuming the original operation was sufficient.
Investigation priorities
Characterise lesion size, morphology, mobility, shadowing, wall change, gallstones and biliary dilatation with prior-image comparison.
Management branches
Ultrasound reports a polypoid gallbladder lesion without a definite invasive mass.
- Verify the image quality, maximum size, sessile or pedunculated morphology, focal wall thickening and comparison with every prior scan.
- Record primary sclerosing cholangitis, age, symptoms, gallstones, comorbidity and whether the person could benefit from future surgery.
Routine pathology unexpectedly identifies gallbladder carcinoma in a removed specimen.
Key medicines
Analgesic ladder for cancer-related painSelect regular non-opioid and, when needed, opioid regimens from the current BNF with individual titration and breakthrough provision.
Antibiotics for tumour-associated cholangitisGive the local emergency biliary-infection regimen at current BNF doses and arrange urgent drainage when malignant obstruction is infected.