Histopathological Spectrum of Gallbladder Lesions & Factors Associated with Metaplastic Changes: A Cross-Sectional Study

Abstract

Introduction: Gallbladder diseases are among the most common disorders requiring surgical intervention, with chronic cholecystitis and cholelithiasis accounting for most cholecystectomy specimens. Chronic inflammation induced by gallstones may result in metaplastic epithelial changes that represent important precursor lesions in gallbladder carcinogenesis.

Aim & Objective: The present study evaluated the clinicopathological spectrum of gallbladder lesions and identified factors associated with metaplastic changes.

Materials & Methods: This hospital-based observational cross-sectional study included 100 consecutive cholecystectomy specimens received in the Department of Pathology over 9 months (September 2024–May 2025). Clinical, demographic, dietary, and radiological data were collected from patient records. Histopathological examination was performed on hematoxylin and eosin-stained sections. Associations between clinicopathological variables and metaplastic changes were analyzed using the Independent Student's t-test, Chi-square test, or Fisher's exact test, followed by multivariable binary logistic regression.

Results: Chronic cholecystitis with cholelithiasis was the most common histopathological diagnosis (57%), while metaplastic changes were identified in 14% of specimens. Patients with metaplasia were significantly older than those without metaplasia (p=0.048). Fat-rich diet (p=0.006), frequent fast-food intake (p=0.015), multiple gallstones (p=0.018), increased gallbladder wall thickness (p<0.001), abnormal body habitus (p=0.043), and weight loss (p=0.019) were significantly associated with metaplastic changes. Multivariable logistic regression identified increasing age (AOR 1.06), fat-rich diet (AOR 3.42), multiple gallstones (AOR 4.58), increased gallbladder wall thickness (AOR 1.87), and weight loss (AOR 2.94) as independent predictors of metaplastic changes.

Conclusion: Chronic cholecystitis with cholelithiasis constituted the predominant gallbladder pathology. Metaplastic changes were significantly associated with chronic inflammatory and dietary risk factors, particularly multiple gallstones and increased gallbladder wall thickness. Routine histopathological examination of all cholecystectomy specimens is essential for the early detection of premalignant lesions and may facilitate timely identification of patients at increased risk for gallbladder carcinoma.

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