Chronic Cholecystitis

 Radiolucent cholesterol stones


image Risk factors: Old age, female sex, obesity, hyperlipidemia

image Radiopaque pigment stones

image Risk factors: Chronic hemolysis, biliary infection, and gastrointestinal diseases affecting bile salt reabsorption





Clinical Issues




• More common in women; ∼ 3:1


Microscopic




• Predominantly mononuclear inflammatory infiltrate with lymphocytes dominating over plasma cells and histiocytes
• Minor component of eosinophils and neutrophils may be present

• Wall thickening secondary to muscular hypertrophy and fibrosis

• Metaplastic changes; most common is antral type

• Rokitansky-Aschoff sinuses

• Histologic variants

image Follicular cholecystitis: Prominent lymphoid follicles

image Lymphoplasmacytic sclerosing cholecystitis (IgG4-related): Often associated with autoimmune pancreatitis

image Eosinophilic cholecystitis: > 90% of infiltrate composed of eosinophils


Top Differential Diagnoses




• Normal gallbladder

• Acute cholecystitis


Diagnostic Checklist




• Presence of gallstones is neither necessary nor sufficient for diagnosis of chronic cholecystitis

image
Gallstones
Gallbladder with multiple mixed stones is shown. Most chronic cholecystitis cases are associated with stones; however, symptomatic stones can be present in histologically normal gallbladder.


image
Porcelain Gallbladder
Thick, fibrotic gallbladder shows dystrophic calcification image reminiscent of porcelain. This variant is associated with an increased risk of adenocarcinoma.

image
Rokitansky-Aschoff Sinuses
The mucosa herniates through the muscularis propria, resulting in Rokitansky-Aschoff sinuses image. This is a common finding in chronic cholecystitis, but is not sufficient for the diagnosis by itself.

image
Follicular Cholecystitis
Multiple lymphoid follicles are shown with germinal centers in the gallbladder mucosa and wall image. In some cases, these follicles can have a polypoid appearance on gross examination.


TERMINOLOGY


Definitions




• Chronic inflammation of gallbladder


ETIOLOGY/PATHOGENESIS


Pathogenesis




• Almost always associated with gallstones
image Cholesterol stones (80% in West): Supersaturation of bile with cholesterol

– Risk factors: Old age, female sex, obesity, hyperlipidemia

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  2. Autoimmune Pancreatitis
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  4. Biliary Atresia

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

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