Acute Cholecystitis

 Inflammation may be sparse in early disease


image Edema and congestion seen in early disease


• Inflammation dominated by neutrophils and variable necrosis in later stages of disease

• Widespread fibroblastic proliferation can occur

• Transmural fibrosis and Rokitansky-Aschoff (RA) sinuses, stigmata of chronic cholecystitis, may be present

• Variant forms
image Xanthogranulomatous: Foamy macrophages as a result of response to bile due from ruptured RA sinuses

image Emphysematous: Necrotic wall with gas bubbles and often contains gram(+) bacilli

image Eosinophilic: Eosinophils comprise > 90% of infiltrate; may be associated with parasites, hypereosinophilic syndrome




Top Differential Diagnoses




• Chronic cholecystitis

• Dysplasia or carcinoma

image
Thickened Wall
The thickened wall and congested mucosa suggest acute cholecystitis in this gallbladder. The gallstone image impacted in the neck of the gallbladder was the etiology of acute cholecystitis.


image
Early Changes
Early acute cholecystitis may show marked edema and hemorrhage but minimal inflammation. Dilation of capillaries and lymphatics can occur. Also note the reactive fibroblasts image .

image
Acute Inflammatory Exudate
A case of severe acute cholecystitis shows mural necrosis, fresh hemorrhage, and a prominent neutrophilic exudate.

image
Transmural Necrosis
Diffuse ulceration, fresh hemorrhage, and full thickness necrosis of the muscularis propria are characteristic of acute cholecystitis. The term necrotizing cholecystitis has been used to describe this phase of the disease.


TERMINOLOGY


Definitions




• Acute inflammation of gallbladder


ETIOLOGY/PATHOGENESIS


Acute Calculous Cholecystitis




• Key elements are obstruction of cystic duct by stones and bile supersaturated with cholesterol
• Trauma to mucosa releases phospholipase from lysosomes

image Phospholipase converts lecithin in bile to lysolecithin, which damages gallbladder epithelium

• Secondary bacterial infection with enteric organisms occurs in 20% of cases

• Overgrowth by gas-producing organisms leads to emphysematous cholecystitis

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Acute Cholecystitis

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