Histological analysis of chronic inflammatory patterns in the gall bladder

Abstract

INTRODUCTION: Cholecystectomy is a common surgical procedure. Inflammatory disease is the most common pathology of the gallbladder. OBJECTIVE: To assess the different morphological changes of chronic cholecystitis in cholecystectomy specimens. METHODS: Thirty histological specimens from cholecystectomies from patients clear clinical history of biliary lithiasis were histologically evaluated with Haematoxylin-Eosinstaining. Three samples were obtained from fundus, middle third and the neck respectively from each gallbladder. RESULTS: 76% of the specimens had metaplastic epithelial changes. Hyperplasia showed a positive correlation (1.0000) with chronic inflammation. Regenerative morphology of epithelial cells was found in 73% of the cases. Regenerative epithelium showed a positive correlation (1.0000) with presence of neutrophils and was significantly associated with mucosal erosions (P=0.005). Fibrosis was observed in all cases (26% mild, 62% moderate, 12% severe). Moderate degree showed a positive correlation (0.999) with severe chronic inflammation. Activity was present in 29% of the cases. Muscular thickness was considered mild in 55% of cases, moderate in 37%, and severe in 8%. Adipose tissue deposits were mild in 47% of cases, moderate in 38%, and severe in 15%. Evolution of the chronic inflammatory cholecystitis was observed in four stages. Initial stage is characterized by mild fibrosis, often with cellular foci, admixed with granulation type tissue in superficial portions of the wall, mild to moderate mononuclear infiltrate and absence of Rockitansky Aschoff sinus(RAS). The second stage consisted of moderate fibrosis and inflammatory infiltrate, often with mild amounts of adipose tissue with RAS extending in to one-third of the length of the specimen. The third stage showed severe fibrosis and chronic inflammation, with moderate to severe adipose tissue deposits with RAS extending in to two-third of the length. The final stage was that of severe fibrosis, often laminated, with reduction of adipose tissue, a moderate to severe inflammatory infiltrate with RAS extending almost entire length of the specimen. CONCLUSION: Staging of chronic inflammatory changes in the gallbladder might help in evaluation of the cholecystectomy specimen, to give a rational, systematic, and reproducible diagnosis of different patterns of the inflammatory process.