Spectrum of histopathological changes in cholecystitis

Abstract

Introduction: Diseases of the gallbladder form an important component and are in fact the bread and butter of routine surgical practice. Though traditionally considered to be a disease of middle aged obese females, the stereotype does not always apply to clinical cases as it can occur in both younger and older age groups of either sex. The histopathological picture of cholecystitis is varied and interesting for validating the clinical diagnosis and confirming the findings of ultrasonography. Aims and objectives: is to study the histopathology of the gallbladder in cases of cholecystitis from operative specimens and compared the tissue architecture with that of the normal gallbladder obtained from freshly donated cadavers to the Dept. of Anatomy. Methods: 60 specimens of gall bladder were procured from cases of cholecystitis during operation from the Dept. of Surgery at KIMS &RF, Amalapuram over a period of one year and 5 specimens of the normal gall bladder were collected from freshly donated cadavers. Results : In cases of cholecystitis the histological picture showed mucosal erosion/ulceration 47 cases (F=37/ M=10) with Smooth muscle hypertrophy and fibrosis present in 29 cases (25 female). Mono nuclear infiltration was the commonest histological change occurring in all layers of the gallbladder in 58 cases of which the majority were female patients (M=12/F=46). Glandular hyperplasia was present in 40 cases. Most of the cases were diagnosed by histopathological examination as chronic cholecystitis, with only two cases of acute cholecystitis and incidental findings of carcinoma in situ in three cases. Metaplastic changes were present in only 2 cases with both of them occurring in male patients. Dysplastic changes were present in 8 cases, (4 male & 4 female). Carcinoma in situ was present in 3 cases, underlining the necessity of meticulous histopathological examination in all cases of cholecystectomy. Conclusion: The findings of the present study will hopefully help surgeons and histopathologists to get a coherent picture of the tissue changes in cholecystitis and remain vigilant for carcinomatous changes in the gall bladder associated with long standing cholecystitis associated with gall stones.