In India, gallbladder cancer (GBC) is most prevalent in the northern and northeastern states as reported by Nandakumar et al. (Int J Cancer 116(5):740–754, 2005). The presenting symptoms are typically vague, and diagnosis commonly occurs at an advanced stage. Structural changes in the gallbladder include mass (40–65%), focal or diffuse parietal thickening (20–30%), and intraluminal polyps (15–25%) as discussed by Pilgrim et al. (Dig Dis Sci 58(9):2455–2462, 2013). Patient data were collected retrospectively from the hospital database between December 2020 and July 2023. A total of 82 patients were included. Surgical procedures included both open and laparoscopic cholecystectomies. Intraoperative frozen sectioning was performed for every patient, and further surgical planning was performed. All the statistical analyses were performed using SPSS for Windows. Fifty-one patients (62%) had malignant disease according to final histopathology. In that subset of patients (malignant), the mean age was 54.8 years and female to male ratio was 4.6:1. On cross-sectional imaging, most of the patients (82%) had thickening of the fundus and body region. On frozen section, 47 patients (57.3%) were positive, and 10 (12.2%) were suspicious for malignancy. On final histopathology, the most common histology was well-differentiated adenocarcinoma (45%). Forty-three percent of malignant patients had concomitant gallstones. Only 22 patients had positive lymph nodes (N +). The mean number of lymph nodes harvested was 8.23 ± 0.57, while the mean positive yield was 1.15 ± 0.3. The observed 62% malignant transformation rate combined with high incidence of female disease and late-stage diagnosis emphasizes the need for improved diagnostic strategies and timely intervention. This study highlights the utility of frozen sections in surgical decision-making and the pressing need for specialized centers, multidisciplinary collaboration, and standardized protocols to address the challenges of identifying gallbladder malignancies.