Spectrum of Histopathological Lesions in Cholecystectomy Specimens at Pak Red Crescent Teaching Hospital

Objective: To study the spectrum of histopathological lesions found on surgically resected gallbladder to quantify the various abnormalities in gallbladder specimen. Methodology: A descriptive observational study was carried out from Nov 2017 to Oct 2021. All the patients undergoing emergency and elective cholecystectomy regardless of age and sex were included in the study. After cholecystectomy, gallbladder specimen along with history and ultrasound findings was sent for histopathology to our own institution. Department of histopathology has the standardized method to process the gallbladder specimens. Demographic data along with diagnosis, ultrasound finding and histopathology report were collected and analyzed with Excel 2019. Results: Total number of patients in this study was 395, out of which 93 patients were male and 302 patients were female. Average age of our patients was 43.05± 13 years. Acute calculus cholecystitis was found in 55 (13.92%) patients, 298 (75.44) patents had chronic calculus cholecystitis, empyema was found in 15 (3.80) patients, cholestrolosis was found in 5 (1.27%) patients, gallbladder polyp was found in 02 (0.51%) patients, gangrenous gall bladder was found in 01 (0.25%) patient and adenocarcinoma in situ was found in 01 (0.25%) patient. Conclusion: Our study shows that, chronic cholecystitis is the most common presentation followed by acute cholecystitis in surgically resected gallbladders. Females are predominantly suffering from the gallbladder diseases. The frequency of malignant lesion was very low. Keywords: Gallbladder-histopathology, Acute Cholecystitis, Chronic Cholecystitis, Gallstones.

P-BN21 Diagnostic accuracy of transabdominal ultrasound for assessing gallbladder polyps

Background Gallbladder polyps are common findings on transabdominal ultrasound (TAUS) and their implications are not entirely clear. Current guidelines advise monitoring with serial TAUS and to offer laparoscopic cholecystectomy if criteria are met to minimise risk of malignant transformation. TAUS is easily accessible and useful at identifying gallbladder polyps, however, has limitations when differentiating between pseudopolyps and true gallbladder polyps with malignant potential. This study looks at a district general hospital’s outcomes for patients undergoing laparoscopic cholecystectomy for gallbladder polyps. Methods This retrospective study identified patients who had polyps identified on TAUS and subsequently undergone laparoscopic cholecystectomy from 2011 to 2021. We identified patients using hospital coding and subsequently assessed their pre-operative imaging and clinic letters to ensure gallbladder polyps were the reason for cholecystectomy. The size of polyp on TAUS was noted and pathology reports were assessed to determine if polyps had been correctly identified on TAUS and if these were true or pseudopolyps. Clinic letters were assessed to determine if patients were symptomatic pre-operatively. Results 66 patients were identified as having polyps pre-operatively. The size of polyp ranged from 2-19mm with a mean of 7.4mm. 39 (59%) patients were symptomatic pre-operatively. TAUS findings correlated with pathology findings of polyps in 45 (68%) patients. Of the 21 patients with no polyps on pathology: 11 had gallstones, 9 had chronic cholecystitis and 1 normal gallbladder. Of the polyps identified 44 were pseudopolyps and only 1 was a true adenoma – 39 cholesterol polyps, 3 inflammatory polyps and 2 adenomyomatosis. There was no evidence of dysplasia on the adenoma, it measured 5mm on TAUS and the patient was symptomatic. Conclusions This study highlights the limitations of TAUS in correctly identifying true polyps. The 41% of asymptomatic patients all had benign findings on pathology and likely had no benefit from surgery. Whilst TAUS is a useful method of identifying potential polyps these findings would suggest that other methods of identifying true polyps should be sought to minimise patients undergoing unnecessary surgery.

P-BN38 Patient Outcomes Following Laparoscopic Cholecystectomy after a Diagnosis of Gall Bladder (GB) Polyp over 10 Years

Background Gall Bladder (GB) polyps are elevations of the GB wall that project into the lumen. They are a rare incidental radiological finding with prevalence of 0.3% to 9.5%. Although the majority of these may be pseudopolyps correct follow up and management is essential as to ensure that true polyps, which may be malignant or have malignant potential, are not missed. We conducted a retrospective study assessing patient factors that may predispose to the finding of true polyps. Patient outcomes including histological findings as well as ongoing symptoms and further investigations or emergency attendances were also assessed. Methods Patients were identified for this retrospective ten year cohort study using International Statistical Classification of Diseases and Related Health Problems (ICD 10) code K 82.8, other specified diseases of gall bladder. Patients with other diagnoses such as gall bladder dysfunction were excluded after review of electronic patient record (EPR) (Sunrise, Allscripts). EPR allowed for review of emergency attendances, clinic letters, investigations and histological results for those diagnosed with a gall bladder polyp. Analysis was performed with Microsoft Excel. Results 35% patients had a laparoscopic cholecystectomy and the average wait time for surgery was 19 months but only 11% of patients were found to have true GB polyps on histology. Other histological findings included chronic cholecystitis (96%), cholesterolsis (33%) and stones 35%. Only 12% of those booked straight to laparoscopic cholecystectomy re-presented post operatively compared to 37% of those operated on after a period of surveillance. Patients booked straight for laparoscopic cholecystectomy, or diagnosed with polyps >10mm in size, were statistically more likely to have a true GB polyp (P < 0.05), however, gender, ethnicity, and whether an isolated polyp or multiple were diagnosed made no statistical difference to detection of a true polyp (P > 0.05). Conclusions From this series of patients true polyps are most likely to be identified if it is larger than 10mm at diagnosis and operated on straight away. 96% of all patients, however, displayed histological features of chronic cholecystitis. This suggests that proceeding to laparoscopic cholecystectomy straight from diagnosis of a GB polyp can be justified. Only 1patient in our cohort returned normal GB histology.. Following diagnosis of a GB polyp, the option of operation versus surveillance should be discussed wirth individual patients and decisions based on assessment of risks and benefits should be made. Further research will help identify those with a predisposition to high-risk true polyps.

Chronic Cholecystitis of Dogs: Clinicopathologic Features and Relationship with Liver

(1) Background: Chronic cholecystitis of dogs has not been vigorously investigated histopathologically. In addition, the relationship between gallbladder and liver diseases is not known. (2) Methods: We aimed to provide a hallmark for canine chronic cholecystitis using clinical data, histopathology, histochemistry, immunohistochemistry, and statistical analysis. (3) Results: Our investigation of 219 ultrasonographically abnormal surgically resected canine gallbladders revealed 189 cases (86.3%) of mucosal lymphoplasmacytic infiltration (chronic cholecystitis). Sludge, a gravity-dependent or nondependent fine granular hyperechoic material, was more prevalent (105/219, 47.9%) than mucocele (51/219, 23.2%) in this cohort. Mucosal lymphoid follicles were detected in 68/219 cases (31%), suggesting the influence of long-standing antigenic stimulation. Bacteria were histochemically detected in 41/60 (68.3%) of heavily inflamed gallbladders, 18/129 (14%) of lightly inflamed, and 3/18 (16.7%) of uninflamed gallbladders, suggesting a possible relationship between bacteria and chronic cholecystitis. Simultaneous liver biopsies revealed mild or no inflammation, changes consistent with primary portal vein hypoplasia, and mild hepatocellular degeneration. (4) Conclusions: Based on the results of our statistical analysis, we conclude that canine chronic cholecystitis is a long-standing inflammatory process of unknown (but possibly bacterial) etiology and that liver pathology is unlikely the cause of chronic cholecystitis in dogs.

Follicular cholecystitis with cholelithiasis – A diagnostic pitfall

Follicular Cholecystitis (FC) is an extremely rare subtype of Chronic Cholecystitis (CC). It is characterized by hyperplastic lymphoid follicles along with prominent germinal centers. It constitutes about 2% of routine cholecystectomies. In this article, we report a case of FC in a 69 years lady. She had abdominal pain, clinically diagnosed as Calculus cholecystitis and managed by laparoscopic cholecystectomy. Grossly, thickening of the gall bladder wall was noted. Histopathological examination revealed gall bladder wall infiltrated by dense lymphoid infiltrate forming lymphoid follicles with prominent germinal centres. Hence, we rendered a diagnosis of FC. The purpose of presenting this case is to make pathologists aware about this entity. One should not mistake this lesion for lymphoma. A careful histopathological examination is diagnostic and Immunohistochemistry may be helpful in difficult cases.Follicular Cholecystitis is extremely rare variant of Chronic cholecystitis. It is characterized by at least 3 Lymphoid Follicles per cm of Gall Bladder tissue with inflammatory infiltrate composed almost exclusively of scattered well-formed Lymphoid Follicles. Pathologist must be familiar with this entity to avoid misdiagnosis of lymphoma.

On the diagnosis of chronic cholecystitis and the clinical significance of some methods for the study of bile

The problems of liver and biliary tract pathology occupy a prominent place among the problems attracting special attention of clinicians.

Experience of using galvanopalpation in the diagnosis of chronic cholecystitis

The principle of galvanopalpation was first proposed by Kagane and further developed by Albrecht. E. T. Zalkindson, M. N. Tumanovsky and others.

The biliary continuum: an up-to-date look at biliary tract diseases

In the structure of gastrointestinal diseases, the pathology of the hepatobiliary system currently ranks second in frequency of occurrence. The stages of diseases of the biliary system can be combined into the so-called “biliary continuum”, when one patient has a consistent development of pathogenetically related diseases of the biliary tract. The progressive course of functional motility disorders of the biliary tract gradually leads to the development of organic pathology, including chronic cholecystitis, the subsequent development of gallstone disease and possible postcholecystectomy complications. Among the diseases of the biliary system, one of the most frequently used diagnoses is chronic cholecystitis. The development of chronic cholecystitis is associated with repeated attacks of acute inflammation or prolonged irritation of large gallstones. The clinical aspects of chronic cholecystitis and other pathologies included in the the «biliary continuum» largely depends on concomitant dyskinesia. There are several directions for the treatment of pathologies of the biliary system: diet therapy, medication, endoscopic and surgical treatment. According to the latest guidelines, the most important direction in modern therapy of diseases of the biliary system is the restoration of the motility of the biliary tract and the normalization of the physicochemical properties of bile. The central place in the treatment of diseases of the “biliary continuum” is given to antispasmodic drugs. The administration of antispasmodics is recommended in order to relieve biliary pain and dyspeptic symptoms caused by spasm of smooth muscles, as well as to control the inflammatory process due to a decrease in the release of pro-inflammatory substances. This article describes in detail the importance of the recovery of the biliary tract motor activity and the improvement of the physico-chemical properties of bile acids.

Gallbladder influence on carbohydrate metabolism in patients with ischemic heart disease and first-detected hyperglycemia

Aim — to determine the changes in carbohydrate metabolism in case of intact gallbladder(GB) and its disorders including the condition after cholecystectomy in patients with coronary heart disease (CHD). Materials and methods. Examinations involved 71 inpatients (52.11 % males, 47.89 % females, median age 65 years) with various forms of CHD (acute coronary syndrome, acute myocardial infarction, postinfarction cardiosclerosis), who were treated in cardiological and infarctional wards. All patients were divided into groups depending on the sonographically determined GB status: the 1st group (n = 30) with intact GB, 2ndgroup (n = 24) with inflections, sludge or signs of chronic cholecystitis, the 3rd group (n = 7) withcholelithiasis and calculous cholecystitis, the 4th(n = 10) with the history of cholecystectomy. Thegroupswereage- and no­sology-matching. Apart from routine investigations, 20 parameters of glucose metabolism were determined: oral glucosetolerance test (OGTT) with the estimation of glucose, insulin and C-peptide levels at baseline (0’) and on 30, 60 and 120 minutes after taking of 75 g of glucose; glycated hemoglobin(НbА1c) levels; increasing areas under curves in the early and late phases for glucose (iAUCG 0-30’, 30-120’) and insulin (iAUCI 0-30’, 30-120’); seevral indexes (HOMA-IR, Quicki, Matsuda, Shuster, DeFronzo). Results. It has been established that GB disorders were accompanied by the significantly less frequent normal glucose metabolism (6.4 % vs 26.7 %) and higher diabetes incidence (19.4 % vs 3.3 %, both p < 0.05) compared to the intact GB. GB condition did not affect the liver insulin sensitivity, the peripheral tissues’ insulin sensitivity, liver clearance of insulin, C-peptide level, as well as the early or late insulin secretion phase, although it was significantly associated with glycemia levels, glycated hemoglobin and the ratio between insulin secretion and the tissue sensitivity. The worst condition of carbohydrate metabolism was observed in case of sludge, GB deformations and signs of chronic cholecystitis: these changes were accompanied by significantly higher glycemia at all points (0’, 30’, 60’, 120’), bigger area under curve for glucose in the late phase (30—120’), higher glycated hemoglobin and lower DeFronzo index. The condition after cholecystectomy was associated with a lower level of glycated hemoglobin, although during the first hour after glucose loading levels of glycemia exceeded the values of people with intact GB. Conclusion. The gallbladder condition affects carbohydrate metabolism, and its pathological changes are associated with a deterioration of carbohydrate balance.