Eosinophilic Cholecystitis

Published on 21/04/2017 by admin

Filed under Pathology

Last modified 21/04/2017

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 Probably not distinct entity, but rather descriptive designation with associated clinical correlates

Etiology/Pathogenesis

• Majority of cases have no known cause or disease association

• Some associated with hypersensitivity reactions, parasitic infection, other eosinophilic diseases
image Hypersensitivity reaction to bile and bile stones has been hypothesized but never proven

Clinical Issues

• Presenting signs are similar to other forms of cholecystitis
• Peripheral eosinophilia variably present
• Typically acalculous
• Diagnosis virtually always made following resection of gallbladder for symptomatic disease

Macroscopic

• Thickened gallbladder wall, usually without gallstones

Microscopic

• Dense eosinophilic infiltrate of gallbladder ± lymphocytic inflammatory component

image Typically > 50% of inflammatory infiltrate is composed of eosinophils
image So-called lymphoeosinophilic cholecystitis shows significant component of lymphocytes as well
image In “true” or “pure” eosinophilic cholecystitis, close to 100% of inflammatory component is composed of eosinophils
• Specimen should be carefully evaluated for parasites
image
Transmural Eosinophilic Infiltrate
This case of eosinophilic cholecystitis shows a transmural infiltrate consisting of both lymphocytes and a prominent component of eosinophils.

image
Pure Eosinophilic Infiltrate
This case of “pure” eosinophilic cholecystitis shows an exclusively eosinophilic infiltrate extending into the muscular wall of the gallbladder.
image
“Pure” Eosinophilic Infiltrate, High Power
This high-power view of “pure” eosinophilic cholecystitis shows the eosinophils within the wall of the gallbladder as well as surrounding vessels. However, unlike eosinophilic vasculitis, the vessels are not significantly infiltrated or damaged.
image
Mixed Lymphocytic/Eosinophilic Inflammation
Some cases of eosinophilic cholecystitis also have admixed lymphocytes in the inflammatory infiltrate, but typically > 50% of the infiltrate is composed of eosinophils.

TERMINOLOGY

Abbreviations

• Eosinophilic cholecystitis (EC)

Definitions

• Inflammatory disease of gallbladder in which inflammatory infiltrate is composed predominantly of eosinophils

image Some advocate for reserving this term for cases in which infiltrate is purely eosinophilic
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