Indications for surgical removal of polypoid lesions of the gallbladder include

Polypoid lesions of the gallbladder are found most often in the third through fifth decades of life and are increasingly being detected by ultrasonography. These are generally small lesions that typically do not show a shadow on ultrasound. Ninety percent are benign lesions, such as cholesterol polyps (pseudotumor). True adenomas constitute about 10% of these benign lesions, but they can undergo malignant transformation. The indications for operative intervention remain controversial. Recent reviews suggest that the vast majority of malignant polypoid lesions are solitary, larger than 1.0 cm, and much more common in patients greater than 50 years of age. There is also an increased incidence of malignancy if the lesions are associated with gallstones. Symptomatic lesions should be removed regardless of their size. Asymptomatic small lesions can probably be safely followed by ultrasonography.