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
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
Typically > 50% of inflammatory infiltrate is composed of eosinophils
So-called lymphoeosinophilic cholecystitis shows significant component of lymphocytes as well
In “true” or “pure” eosinophilic cholecystitis, close to 100% of inflammatory component is composed of eosinophils
• Specimen should be carefully evaluated for parasites
Transmural Eosinophilic Infiltrate This case of eosinophilic cholecystitis shows a transmural infiltrate consisting of both lymphocytes and a prominent component of eosinophils.
Pure Eosinophilic Infiltrate This case of “pure” eosinophilic cholecystitis shows an exclusively eosinophilic infiltrate extending into the muscular wall of the gallbladder.
“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.
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
Some advocate for reserving this term for cases in which infiltrate is purely eosinophilic
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