Predictive factors for incidental gallbladder dysplasia and carcinoma.

BACKGROUND: This study aims to analyze clinical characteristics and demographics of all patients admitted for cholecystectomy in a tertiary referral center to determine predictors of incidental gallbladder dysplasia (IGBD) and incidental gallbladder carcinoma (IGBC). METHODS: A retrospective analyses of clinical, demographic, and histologic features of patients undergoing cholecystectomy in a single tertiary institution from 2005-2012 were performed using a logistic regression model to determine the predictors of IGBD and IGBC. RESULTS: Some 771 (28 conversions to open surgery [3.6%]) and 93 patients (10.7%) underwent laparoscopic and open cholecystectomies for gallstone disease, respectively. At final pathology, IGBD (low-grade [n = 10], high-grade [n = 2], mixed-grade [n = 1], and adenoma-associated [n = 5] dysplasia) was found in 18 patients (2%; median age, 45 y; interquartile range, 42.5-63.5; male-to-female ratio, 1:2; six Caucasian; and 12 Asian). IGBC was found in seven patients (0.8%; median age, 69 y; interquartile range, 69-72; one Afro-Caribbean; four Caucasian; and two Asian). Logistic regression analysis revealed Asian patients to be at a higher risk of IGBD (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.1-8.0; P = 0.02). Only age (OR, 1.12; 95% CI, 1.04-1.2; P < 0.01) and polypoid lesions (OR, 37.4; 95% CI, 2.97-470.6; P = 0.01) were significantly associated with IGBC. Receiver operating characteristic curve analysis demonstrated that age >68 y correlated positively to IGBC. CONCLUSIONS: IGBD and IGBC are fairly common incidental histologic finding after cholecystectomy for gallstone disease. When considering cholecystectomy, patients' demographics, in particular age and race, should always be considered as this might help the surgeon and the pathologist to institute the appropriate treatment.

The attitudes of relatives to autopsy: a misconception.

AIM: Hospital autopsy rates have been falling steadily over recent decades. One factor that has been implicated in this decline is the perception that the general public views postmortem examinations unfavourably and that this often makes clinicians reluctant to discuss autopsy with families and seek their consent. The aim of this study was to test this assumption. OBJECTIVES/METHODS: In the division of lymphoid malignancies at St Bartholomew's Hospital, we suggested autopsy and discussed it in depth with the families of all the patients who died in hospital in an 8-month period in order to assess whether the autopsy rate could be increased by improving the approach to the relatives. RESULTS: Consent for a postmortem examination was requested in 18 of 23 cases and granted in 16 cases, giving a consent rate of 89%, and an overall rate of autopsy of 69.5%. CONCLUSION: The attitude of the general public is positive overall, and translates into high autopsy rates when the value of the examination is presented honestly and the details of the procedure are adequately explained.

Biliary Cystadenoma Causing Obstructive Jaundice: Case Report and Literature Review.

Biliary cystadenomas are rare, potentially malignant neoplasms of biliary origin. Presentation is usually with vague and non-specific symptoms. Here, we describe an unusual case of biliary cystadenoma in a woman presenting with acute onset obstructive jaundice and review the relevant literature of 26 such cases reported over the last two decades.