A major concern in the management of the patient with PLG is the potential for malignant transformation, although the relationship between gallbladder polyps and cancer is controversial. Aldridge and Bismuth and others have argued that there is a polyp-cancer sequence, similar to that in the pathogenesis of colorectal carcinoma. Adenomatous polyps appear to have the highest risk of malignant transformation. In a study of 300 randomly selected gallbladders at cholecystectomy, 5% were found to harbour sessile adenomas. Furthermore, 19% of these cases exhibited small foci of moderate cellular atypia, and in 31% of these cases, carcinoembryonic antigen was positive. Kozuka et al reviewed the histology of 1605 resected gallbladders and found 11 benign adenomas, seven adenomas showing malignant change and 79 invasive carcinomas. Supporting evidence for an adenoma-adenocarci-noma sequence from this study included the correlation between the size of the lesion and malignant change, similar to that described in colorectal carcinoma, as well as the discovery of adenomatous components in all of the in situ carcinomas and 19% of the invasive carcinomas. There have also been several case reports of gallbladder polyps developing into gallbladder cancer, and adenomatous polyps containing carcinoma in situ. Further, patients with gastrointestinal polyp syndromes have been reported to develop gallbladder polyps and adenocarcinoma. Although gallbladder adenomas appear to carry the highest malignant potential, other seemingly innocent lesions have been reported to undergo malignant transformation. For example, adenomyomatosis of the gallbladder, which is extension of the mucosa into and through a thickened muscular wall, has historically been considered to be an innocuous lesion. Recently, however, several cases of gallbladder cancer have been described in areas of adenomyomatosis. Similarly, carcinoma in situ has been reported to occur in patients with cholesterol polyps. You can be sure your pharmacy offers *cheap viagra online delivering fast internationally.