Does the Type of Gallstone Influence the Histomorphological Changes in Gallbladder Mucosa?

Background: Gallstone (GS) disease is causally linked to gallbladder (GB) cancer. There is a high prevalence of GB cancer in north and northeastern regions of the Indian subcontinent that is closely linked to the cholesterol and mixed GS. Aim: To retrospectively analyze the histopathology of the GB in patients with and without GS in Tamil Nadu (TN) and Madhya Pradesh (MP). Methodology: Histopathology records of the patients who had cholecystectomy between 2022 and 2024 were included for the analysis. Patient details included age, gender, state of origin, co-morbidity if any, and indication for cholecystectomy. The type of GS, based on morphological characteristics and color was classified as pigment, mixed, and cholesterol. The histopathological changes were correlated with the type of GS with special reference to dysplasia-carcinoma sequence. Results: There were 222 GB specimens available for the analysis: 113 (51%) from TN state, 83 (37.3%) from MP, and remaining 26 (11.7%) from north-eastern (NE) states (operated at the two centers). Across the three regions, there was no difference in the age of presentation ( P = 0.2); gender wise, there were more women from TN and NE while men predominated in MP ( P < 0.01). The prevalence of diabetes was similar in all the three regions. Almost 80% and more patients presented as acute cholecystitis. Black pigment stones were significantly more common in TN (81.4%) and they were predominantly cholesterol in MP (69.9%) and mixed in NE states (46.1%). Chronic cholecystitis was the most common histological finding followed by acute on chronic cholecystitis; none of the specimens with GS had dysplasia or GB cancer. In seven patients who had a mass within the GB on imaging, 3 on histology had adenomyomatosis, mucosal atypia in 2, and carcinoma of GB in 2 (one NE; one TN state); none had GS. Conclusion: GB cancer is uncommon in TN and MP states; its prevalence is independent of the presence of GS.