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Gallbladder

Cholecystitis

Chronic cholecystitis

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)

General
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● Most cholecystectomies are performed for intermittent obstruction of gallbladder neck / cystic duct by gallstones, causing biliary colic
● 95% are associated with cholelithiasis
● 75% women, ages 40+
● Bacteria present in 11-30%, similar organisms as in acute cholecystitis
● Complications: acute cholecystitis, acute pancreatitis, biliary fistulas, choledocholithiasis, gallstone ileus
● IBD Related changes: Two inflammatory patterns that occur more often in ulcerative colitis patients are marked chronic cholecystitis and acute serositis, while nodular lymphoid aggregates are more common in Crohn's disease patients (J Crohns Colitis 2012;6:895)
● Giardia lamblia: associated with IgA deficiency, achlorhydria, malabsorption
● H. pylori: may be present, but association with disease is unclear (J Infect Dev Ctries 2009;3:856)
● Salmonella typhi: associated with chronic carrier states
● Chronic active cholecystitis: with intraepithelial neutrophils
● Rokitansky-Aschoff sinuses: tubular structures present within the wall in 90%, likely herniations or diverticula due to increased intraluminal pressure; called Luschka’s ducts if subserosal

Gross description
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● Variable thickening of gallbladder wall, variable adhesions

Micro description
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● Mild chronic inflammation with Rokitansky-Aschoff sinuses, granulomas (from ruptured Rokitansky-Aschoff sinuses), smooth muscle hypertrophy
● Neuromatous hyperplasia, hyalinized collagen, dystrophic calcification, lymphoid aggregates (5%)
● Variable mucosal changes (normal, atrophic, ulcerated)
● Variable metaplastic change

Micro images
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Thickened wall with Rokitansky-Aschoff sinuses


Atrophic mucosa and fibrotic lamina propria


Metaplastic changes gastric


Intestinal

Virtual slides
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Chronic cholecystitis

Differential diagnosis
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● Normal gallbladder: if minimal inflammation
● Primary sclerosing cholangitis or extrahepatic bile duct obstruction: if abundant plasma cells and no gallstones

Diffuse lymphoplasmacytic acalculous cholecystitis

General
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● Associated with lymphoplasmacytic sclerosing pancreatitis (Am J Surg Pathol 2003;27:441)
● Relatively sensitive for primary sclerosing cholangitis, but does not distinguish between primary and secondary cholangiopathies (Am J Surg Pathol 2003;27:1313)

Micro description
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● Diffuse, mucosal based, dense lymphoplasmacytic infiltrate without cholelithiasis

Micro images
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Various images

End of Gallbladder > Cholecystitis > Chronic cholecystitis

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