Difference between revisions of "Cholecystitis"

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==Microscopic evaluation==
 
==Microscopic evaluation==
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Classify cholecystitis as acute, chronic or both acute and chronic.
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===Findings in '''acute''' cholecystisis===
 
===Findings in '''acute''' cholecystisis===
Typical features:<ref>{{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>
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[[File:Histopathology of lamina propria edema and hemorrhage in acute cholecystitis.jpg|thumb|Lamina propria edema and hemorrhage in acute cholecystitis.]]
*Initially edema, congestion, hemorrhage, fibrin deposition in and around the muscular layer.
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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>
*Later necrosis of the mucosa and and deeper layers, with neutrophils
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*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>
*Variable reactive epithelial changes, which may resemble dysplasia
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*Later often '''necrosis''' of the mucosa and and deeper layers, with neutrophils.<ref name=Gulwani-acute/>
There may be fresh thrombi within small veins
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*Variable '''reactive epithelial''' changes, which may resemble dysplasia.<ref name=Gulwani-acute/>
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There may be fresh '''thrombi''' within small veins.<ref name=Gulwani-acute/>
  
 
===Findings in '''chronic''' cholecystitis===
 
===Findings in '''chronic''' cholecystitis===
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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) strogly favor the diagnosis.
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*'''Granulomas''' (from ruptured Rokitansky-Aschoff sinuses) strongly favor the diagnosis.
*Hyalinized collagen
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*'''Hyalinized collagen'''
*Dystrophic calcification
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*Dystrophic '''calcification'''
*Lymphoid aggregates
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*'''Lymphoid aggregates'''
*Atrophic and/or ulcerated mucosa
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*'''Atrophic''' and/or '''ulcerated''' mucosa
*Metaplastic changes, such as gastric or intestinal mucosa
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*'''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]]'''.''
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 +
===Lymph nodes===
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Look for reactive lymphadenopathy or metastasis. {{further|Lymph node}}
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 +
===Microscopy report===
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Report:
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*Relevant findings from the evaluation.
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*Any cholelithiasis as per the gross report.
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;Template:
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{{Comprehensiveness|noheader=yes|otherlegend=yes}}
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{|class=wikitable
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| {{Moderate-begin}}Gallbladder, cholecystectomy:{{Moderate-end}} <br><<Acute and/or chronic>> cholecystitis. <br>{{Finding-begin}}Cholelithiasis.{{Finding-end}}
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|}
 
{{Bottom}}
 
{{Bottom}}

Revision as of 20:51, 30 November 2020

Author: Mikael Häggström [note 1]
Inflammation of the gallbladder:

Gross processing

As per basic Gallbladder.

Microscopic evaluation

Classify cholecystitis as acute, chronic or both acute and chronic.

Findings in acute cholecystisis

Lamina propria edema and hemorrhage in acute cholecystitis.

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

Rokitansky-Aschoff sinus.

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

  1. 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

  1. 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. 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. 3.0 3.1 Hanni Gulwani. Gallbladder - Cholecystitis - Chronic cholecystitis. Topic Completed: 1 September 2012. Revised: 9 January 2020

Image sources