Difference between revisions of "Cholecystitis"
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− | + | Inflammation of the '''[[gallbladder]]''': | |
+ | |||
+ | ==Gross processing== | ||
+ | As per basic '''[[Gallbladder]]'''. | ||
==Microscopic evaluation== | ==Microscopic evaluation== | ||
+ | Classify cholecystitis as acute, chronic or both acute and chronic. | ||
+ | |||
+ | ===Findings in '''acute''' cholecystisis=== | ||
+ | [[File:Histopathology of lamina propria edema and hemorrhage in acute cholecystitis.jpg|thumb|Lamina propria edema and hemorrhage in acute cholecystitis.]] | ||
+ | Main initial features are '''edema''' and '''hemorrhage'''.<ref name=Mills>{{cite book |author= Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H |title=Sternberg's Diagnostic Surgical Pathology |publisher=Lippincott Williams & Wilkins |location= |year=2009 |pages=|edition=5th |isbn=978-0781779425 |oclc= |doi= |accessdate=}}</ref> | ||
+ | *Initially often also '''congestion''' and '''fibrin deposition''' in and around the muscular layer.<ref name=Gulwani-acute>{{cite web|url=https://www.pathologyoutlines.com/topic/gallbladderacutecholecystitis.html|title=Gallbladder & extrahepatic bile ducts - Cholecystitis|author=Hanni Gulwani|website=Pathology Outlines}} Topic Completed: 1 September 2012. Minor changes: 5 September 2019</ref> | ||
+ | *Later often '''necrosis''' of the mucosa and and deeper layers, with neutrophils.<ref name=Gulwani-acute/> | ||
+ | *Variable '''reactive epithelial''' changes, which may resemble dysplasia.<ref name=Gulwani-acute/> | ||
+ | There may be fresh '''thrombi''' within small veins.<ref name=Gulwani-acute/> | ||
+ | |||
+ | ===Findings in '''chronic''' cholecystitis=== | ||
[[File:Gallbladder- Rokitansky-Aschoff Sinus (15144904071).jpg|thumb|Rokitansky-Aschoff sinus.]] | [[File:Gallbladder- Rokitansky-Aschoff Sinus (15144904071).jpg|thumb|Rokitansky-Aschoff sinus.]] | ||
Typical features are:<ref name=Gulwani2020>{{cite web|url=https://www.pathologyoutlines.com/topic/gallbladderchroniccholecystitis.html|title=Gallbladder - Cholecystitis - Chronic cholecystitis|author=Hanni Gulwani}} Topic Completed: 1 September 2012. Revised: 9 January 2020</ref> | Typical features are:<ref name=Gulwani2020>{{cite web|url=https://www.pathologyoutlines.com/topic/gallbladderchroniccholecystitis.html|title=Gallbladder - Cholecystitis - Chronic cholecystitis|author=Hanni Gulwani}} Topic Completed: 1 September 2012. Revised: 9 January 2020</ref> | ||
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*'''Rokitansky-Aschoff sinuses''' | *'''Rokitansky-Aschoff sinuses''' | ||
Other findings favoring the diagnosis are:<ref name=Gulwani2020/> | Other findings favoring the diagnosis are:<ref name=Gulwani2020/> | ||
− | *Granulomas (from ruptured Rokitansky-Aschoff sinuses) | + | *'''Granulomas''' (from ruptured Rokitansky-Aschoff sinuses) strongly favor the diagnosis. |
− | *Hyalinized collagen | + | *'''Hyalinized collagen''' |
− | *Dystrophic calcification | + | *Dystrophic '''calcification''' |
− | *Lymphoid aggregates | + | *'''Lymphoid aggregates''' |
− | *Atrophic and/or ulcerated mucosa | + | *'''Atrophic''' and/or '''ulcerated''' mucosa |
− | *Metaplastic changes, such as gastric or intestinal mucosa | + | *'''Metaplastic''' changes, such as gastric or intestinal mucosa |
<gallery mode=packed heights=200> | <gallery mode=packed heights=200> | ||
File:Histopathology of eosinophilic cholecystitis.jpg|'''Eosinophilic cholecystitis''' | File:Histopathology of eosinophilic cholecystitis.jpg|'''Eosinophilic cholecystitis''' | ||
</gallery> | </gallery> | ||
''For a general gallbladder screening, see '''[[gallbladder]]'''.'' | ''For a general gallbladder screening, see '''[[gallbladder]]'''.'' | ||
+ | |||
+ | ===Lymph nodes=== | ||
+ | Look for reactive lymphadenopathy or metastasis. {{further|Lymph node}} | ||
+ | |||
+ | ===Microscopy report=== | ||
+ | Report: | ||
+ | *Relevant findings from the evaluation. | ||
+ | *Any cholelithiasis as per the gross report. | ||
+ | |||
+ | ;Template: | ||
+ | {{Comprehensiveness|noheader=yes|otherlegend=yes}} | ||
+ | {|class=wikitable | ||
+ | | {{Moderate-begin}}Gallbladder, cholecystectomy:{{Moderate-end}} <br><<Acute and/or chronic>> cholecystitis. <br>{{Finding-begin}}Cholelithiasis.{{Finding-end}} | ||
+ | |} | ||
{{Bottom}} | {{Bottom}} |
Revision as of 20:51, 30 November 2020
Author:
Mikael Häggström [note 1]
Inflammation of the gallbladder:
Contents
Gross processing
As per basic Gallbladder.
Microscopic evaluation
Classify cholecystitis as acute, chronic or both acute and chronic.
Findings in acute cholecystisis
Main initial features are edema and hemorrhage.[1]
- Initially often also congestion and fibrin deposition in and around the muscular layer.[2]
- Later often necrosis of the mucosa and and deeper layers, with neutrophils.[2]
- Variable reactive epithelial changes, which may resemble dysplasia.[2]
There may be fresh thrombi within small veins.[2]
Findings in chronic cholecystitis
Typical features are:[3]
- Smooth muscle hypertrophy in the muscularis
- Mild inflammatory infiltrates
- Rokitansky-Aschoff sinuses
Other findings favoring the diagnosis are:[3]
- Granulomas (from ruptured Rokitansky-Aschoff sinuses) strongly favor the diagnosis.
- Hyalinized collagen
- Dystrophic calcification
- Lymphoid aggregates
- Atrophic and/or ulcerated mucosa
- Metaplastic changes, such as gastric or intestinal mucosa
For a general gallbladder screening, see gallbladder.
Lymph nodes
Look for reactive lymphadenopathy or metastasis. Further information: Lymph node
Microscopy report
Report:
- Relevant findings from the evaluation.
- Any cholelithiasis as per the gross report.
- Template
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
- Other legend
<< Decision needed between alternatives separated by / signs >>
{{Common findings / In case of findings}}
[[Comments]]
Link to another page
(Gallbladder, cholecystectomy:) <<Acute and/or chronic>> cholecystitis. {{Cholelithiasis.}} |
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. ISBN 978-0781779425.
- ↑ 2.0 2.1 2.2 2.3 Hanni Gulwani. Gallbladder & extrahepatic bile ducts - Cholecystitis. Pathology Outlines. Topic Completed: 1 September 2012. Minor changes: 5 September 2019
- ↑ 3.0 3.1 Hanni Gulwani. Gallbladder - Cholecystitis - Chronic cholecystitis. Topic Completed: 1 September 2012. Revised: 9 January 2020
Image sources