The authors report on a series of 324 patients operated on for cholelithiasis. They summarize the histological findings obtained by detailed examination of the surgical specimens carried out by one pathologist. The relatively high rate (43%) of severe pathological changes in the gallbladder wall in emphasized as these may be sites of predilection for the development of carcinoma. Three cases of only histologically established carcinoma are briefly described. In two of them carcinoma developed on the basis of chronic fibroproductive cholecystitis. In the third case the gall bladder was not removed and thus histologically not examined. In the light of their findings, the authors strongly advocate early cholecystectomy, particularly in patients of advanced age groups.