Papilloma of the gall bladder

B ENIGN tumors of the gaII bIadder were considered rare unti1 MacCarty described choIecystitis catarrhaIis papiIIomatosa in rgr o; he was the first in this country to describe the condition. About the time of his report, choIecystectomy began to be recognized more and more as the best procedure in treating many cases of disease of the gaI1 bIadder. With this change in surgica1 procedure, more thorough examination of the interior of the gaI1 bIadder couId be carried out, and papiIIomas began to be seen more frequentIy by the surgica1 pathoIogist. This increasing incidence of recognition of the condition is evident in the papers of Irwin and MacCarty, C. H. Mayo, Keene, M8IIe, AbeII, and MacCarty. My study was of a group of 500 gaI1 bIadders, surgicaIIy removed at The Mayo Clinic between 1923 and rg2g which proved to contain one papiIIoma or more. These gaI1 bIadders were taken consecutiveIy as they appeared in the course of a11 operations on the gaI1 bIadder. SpeciaI attention was given to the reIationship of papiIIoma t.o maIignancy, and to other diseases of the gaII bIadder. The corresponding cIinica1 histories were reviewed. The incidence by age of patients was found to be as foIIows: ten to twenty years, 0.4 per cent; twenty to thirty years, 6.2 per cent; thirty to forty years, 2g per cent; forty to fifty years, 30.8 per cent; fifty to sixty years, 27.6 per cent, and sixty to seventy years, 6 per cent. Of the patients from whom the gaII bIadders were derived, 68.4 per cent were femaIes. From these figures the high incidence of papiIIomas among patients of the comparativeIy earIy age group of thirty to forty years wiI1 be noted. PapiIIomas rareIy occur before the third decade of Iife. Records of post-mortem examinations made at the cIinic from 1922 to 1930 in cases in which death was from other causes than disease of the gaI1 bIadder discIose that onIy 3 cases of papiIIoma of the gaI1 bIadder were found among patients who were Iess than thirty years of age. These three patients were, respectiveIy, twentytwo, twenty-four and twenty-six years of age. Mentzer, in his study of 633 consecutive postmortem examinations, found onIy one patient Iess than thirty years of age who had papiIIomatous choIecystitis. AI1 the sections studied microscopicahy gave evidence of inflammation, either in an acute, subacute, or chronic form, but by far the greatest number were exampIes of so-caIIed chronic catarrha1 choIecystitis, as is shown by infiItration of the submucosa by smaI1 round ceIIs. EtioIogicaIIy I think two factors present themseIves in the formation of papiIIomas: in one group infection pIays the important part; in a second group, infection and metaboIic disturbances work together. By far the Iarger number of cases wiI1 faI1 in the Iatter group. In the cases of true inffammation, the gross appearance is that of papiIIary projections from the mucous membrane of the gaI1 bladder; the coIor of the papilloma resembIes that of the mucous membrane. The pedicIe is of about the same size as the growth (Fig. I). The growth, therefore, does not break off easiIy, but, as wiI1 appear, papiIIomas of the type next to be described do break off. MicroscopicaIIy, the papiIIomas appear as projections with many branches, with very Iittle stroma,