Quentin Ballouhey1, Aurélien Binet2, François Varlet3, Manon Baudry4, Rémi Dubois5, Géraldine Héry6, Guillaume Podevin7, Olivier Abbo8, Alexis Arnaud9, Marc Barras10, Florent Guerin11, Olivier Reinberg12, Christian Piolat13, Laurent Fourcade4. 1. Department of Pediatric Surgery, Hôpital des Enfants, Toulouse, France. 2. Department of Pediatric Surgery, CHU Tours, Tours, France. 3. Department of Pediatric Surgery, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Rhône-Alpes, France. 4. Department of Pediatric Surgery, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France. 5. Department of Pediatric Surgery, Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France. 6. Department of Pediatric Surgery, CHU Marseille, Marseille, France. 7. Department of Pediatric Surgery, Centre Hospitalier Universitaire d'Angers, Angers, Pays de la Loire, France. 8. Department of Pediatric Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrénées, France. 9. Department of Pediatric Surgery, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France. 10. Department of Pediatric Surgery, CHRU de Brest, Brest, Bretagne, France. 11. Department of Pediatric Surgery, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France. 12. Department of Pediatric Surgery, Bibliotheque Cantonale et Universitaire Lausanne, Lausanne, Switzerland. 13. Department of Pediatric Surgery, Centre Hospitalier Universitaire de Grenoble, Grenoble, Rhône-Alpes, France.
Abstract
INTRODUCTION: Polypoid lesions of the gallbladder (PLG) are relatively common in adults, while they are very rare in children. The use of high-quality ultrasonography leads to increased detection of PLG, although less than 20 pediatric cases of primary PLG have been reported in the literature. The aim of this study was to address the experience of PLG management in children. MATERIALS AND METHODS: A retrospective multicenter review of children with ultrasonographically defined PLG between 2006 and 2016 was performed. The data from 12 pediatric surgery centers were compiled for this purpose. RESULTS: Eighteen patients (mean age: 10.4 ± 4.1 years) were included and managed according to each center's protocols. Cholecystectomy was performed for nine symptomatic patients. Histopathology conclusively revealed four tubular and five papillary adenomas, with a median size of 12 mm (ranging from 3 to 35 mm). Nine asymptomatic children were monitored by sonography over a 24-month (ranging from 12 to 66 months) follow-up period. The median PLG size was 7 mm (ranging from 3 to 9 mm). Two lesions disappeared after 1 and 2 years of follow-up, respectively. None of the patients developed symptoms or malignant transformation. CONCLUSION: This report confirms appropriate use of a conservative approach with annual clinical and ultrasound follow-up for small-sized and isolated PLG in children given the absence of malignancy and potential vanishing entities. Surgical treatment should be considered in case of lesions larger than 10 mm in size or when they are associated with symptoms. Georg Thieme Verlag KG Stuttgart · New York.
INTRODUCTION: Polypoid lesions of the gallbladder (PLG) are relatively common in adults, while they are very rare in children. The use of high-quality ultrasonography leads to increased detection of PLG, although less than 20 pediatric cases of primary PLG have been reported in the literature. The aim of this study was to address the experience of PLG management in children. MATERIALS AND METHODS: A retrospective multicenter review of children with ultrasonographically defined PLG between 2006 and 2016 was performed. The data from 12 pediatric surgery centers were compiled for this purpose. RESULTS: Eighteen patients (mean age: 10.4 ± 4.1 years) were included and managed according to each center's protocols. Cholecystectomy was performed for nine symptomatic patients. Histopathology conclusively revealed four tubular and five papillary adenomas, with a median size of 12 mm (ranging from 3 to 35 mm). Nine asymptomatic children were monitored by sonography over a 24-month (ranging from 12 to 66 months) follow-up period. The median PLG size was 7 mm (ranging from 3 to 9 mm). Two lesions disappeared after 1 and 2 years of follow-up, respectively. None of the patients developed symptoms or malignant transformation. CONCLUSION: This report confirms appropriate use of a conservative approach with annual clinical and ultrasound follow-up for small-sized and isolated PLG in children given the absence of malignancy and potential vanishing entities. Surgical treatment should be considered in case of lesions larger than 10 mm in size or when they are associated with symptoms. Georg Thieme Verlag KG Stuttgart · New York.