Acute cholecystitis

Acute cholecystitis
	Diagnosis in short
LM	edema, hemorrhage, +/-neutrophils, +/-reactive epithelial changes
LM DDx	chronic cholecystitis, intestinal metaplasia of the gallbladder, gallbladder dysplasia, adenocarcinoma of the gallbladder
Gross	wall thickening (due to edema), gallstone(s) in the neck (classic finding), +/-mucosal erosions
Site	gallbladder
Associated Dx	choledocholithiasis
Clinical history	elderly individuals (50s and 60s)
Prevalence	uncommon
Radiology	wall thickening (>3 mm), gallstone(s) in the neck
Prognosis	benign, good

Acute cholecystitis is a relatively uncommon gallbladder pathology when compared to chronic cholecystitis. It is usually associated with gallstones and seen in older individuals.

General

Less common than chronic cholecystitis.
Usually due to gallstones.^[1]
Classically older individuals (50s and 60s) with a slight female predominance.^[1]

Notes:

Pathologic diagnosis very often discordant with clinical impression.^[2]

Gross

Features:^[1]

Wall thickening - due to edema and hemorrhage.†
Gallstone(s) - classically obstructing the gallbladder neck.
+/-Mucosal erosions.

Note:

† The sonographic criterium for "thick" is greater than 3 mm.^[3]^[4]

Microscopic

Features:^[1]

Edema.
Hemorrhage.
+/-Fibrin thrombi in small veins.
+/-Mucosal erosions.
+/-Neutrophils - useful
- Not essential for the Dx of acute cholecystitis.
- Neutrophils usually secondary to necrosis/ulceration or infection.^[5]
+/-Reactive epithelial changes.^[6]

Notes:

May see activated fibroblasts.

DDx:

Chronic cholecystitis - has less inflammation, fibrotic wall thickening/muscular hypertrophy, may have RK sinuses.
Gallbladder adenocarcinoma.
Intestinal metaplasia of the gallbladder.

Special types

Gangrenous cholecystitis

General:^[7]

Older.
Clinically "sicker".
Worse outcome than (acute) non-gangrenous cholecystitis.

Microscopic:

Necrosis of gallbladder wall (muscularis propria).^[8]

Sign out

GALLBLADDER, CHOLECYSTECTOMY: 
- ACUTE CHOLECYSTITIS.
- CHOLELITHIASIS.

GALLBLADDER, CHOLECYSTECTOMY:
- ACUTE AND CHRONIC CHOLECYSTITIS WITH MULTIPLE MUCOSAL EROSIONS AND FOCAL NECROSIS OF THE GALLBLADDER WALL.

GALLBLADDER, CHOLECYSTECTOMY:
- GANGRENOUS CHOLECYSTITIS.
- CHOLELITHIASIS.

Micro

The sections show gallbladder wall with hemorrhage, and activated fibroblasts. The superficial mucosa has clusters of neutrophils.

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 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. pp. 1606. ISBN 978-0781779425. Cite error: Invalid <ref> tag; name "Ref_Sternberg5_1606" defined multiple times with different content Cite error: Invalid <ref> tag; name "Ref_Sternberg5_1606" defined multiple times with different content Cite error: Invalid <ref> tag; name "Ref_Sternberg5_1606" defined multiple times with different content
↑ Fitzgibbons, RJ.; Tseng, A.; Wang, H.; Ryberg, A.; Nguyen, N.; Sims, KL. (Dec 1996). "Acute cholecystitis. Does the clinical diagnosis correlate with the pathological diagnosis?". Surg Endosc 10 (12): 1180-4. PMID 8939838.
↑ Tsung, JW.; Raio, CC.; Ramirez-Schrempp, D.; Blaivas, M. (Mar 2010). "Point-of-care ultrasound diagnosis of pediatric cholecystitis in the ED.". Am J Emerg Med 28 (3): 338-42. doi:10.1016/j.ajem.2008.12.003. PMID 20223393.
↑ Kim, HJ.; Park, JH.; Park, DI.; Cho, YK.; Sohn, CI.; Jeon, WK.; Kim, BI.; Choi, SH. (Feb 2012). "Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening.". Dig Dis Sci 57 (2): 508-15. doi:10.1007/s10620-011-1870-0. PMID 21879282.
↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 174. ISBN 978-0470519035.
↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 439. ISBN 978-0443066573.
↑ Nikfarjam, M.; Niumsawatt, V.; Sethu, A.; Fink, MA.; Muralidharan, V.; Starkey, G.; Jones, RM.; Christophi, C. (Aug 2011). "Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis.". HPB (Oxford) 13 (8): 551-8. doi:10.1111/j.1477-2574.2011.00327.x. PMID 21762298.
↑ STC. 25 February 2009.

[Ref_Sternberg5_1606-1] 1.0 ^1.1 ^1.2 ^1.3 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. pp. 1606. ISBN 978-0781779425. Cite error: Invalid <ref> tag; name "Ref_Sternberg5_1606" defined multiple times with different content Cite error: Invalid <ref> tag; name "Ref_Sternberg5_1606" defined multiple times with different content Cite error: Invalid <ref> tag; name "Ref_Sternberg5_1606" defined multiple times with different content

[pmid8939838-2] Fitzgibbons, RJ.; Tseng, A.; Wang, H.; Ryberg, A.; Nguyen, N.; Sims, KL. (Dec 1996). "Acute cholecystitis. Does the clinical diagnosis correlate with the pathological diagnosis?". Surg Endosc 10 (12): 1180-4. PMID 8939838.

[pmid20223393-3] Tsung, JW.; Raio, CC.; Ramirez-Schrempp, D.; Blaivas, M. (Mar 2010). "Point-of-care ultrasound diagnosis of pediatric cholecystitis in the ED.". Am J Emerg Med 28 (3): 338-42. doi:10.1016/j.ajem.2008.12.003. PMID 20223393.

[pmid21879282-4] Kim, HJ.; Park, JH.; Park, DI.; Cho, YK.; Sohn, CI.; Jeon, WK.; Kim, BI.; Choi, SH. (Feb 2012). "Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening.". Dig Dis Sci 57 (2): 508-15. doi:10.1007/s10620-011-1870-0. PMID 21879282.

[Ref_DCHH174-5] Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 174. ISBN 978-0470519035.

[Ref_GLP439-6] Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 439. ISBN 978-0443066573.

[pmid21762298-7] Nikfarjam, M.; Niumsawatt, V.; Sethu, A.; Fink, MA.; Muralidharan, V.; Starkey, G.; Jones, RM.; Christophi, C. (Aug 2011). "Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis.". HPB (Oxford) 13 (8): 551-8. doi:10.1111/j.1477-2574.2011.00327.x. PMID 21762298.

[8] STC. 25 February 2009.

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Acute cholecystitis

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