Histologic analysis of chronic inflammatory patterns in the gallbladder: diagnostic criteria for reporting cholecystitis

Abstract

Cholecystectomy is one of the most common surgical procedures. Inflammatory disease is by far the most common pathology of the gallbladder. Terms for describing cholecystitis are numerous, thus there is no uniform terminology. One hundred cholecystectomies and 10 gallbladders from autopsies were reviewed and inflammatory changes were analyzed. Chronic cholecystitis was seen in 75% of cases with epithelial metaplasia and 73% with regenerative epithelium, the latter being associated with erosion but not with the presence of lithiasis. Muscular thickening and adipose deposits were mostly mild. Inflammation was mild in 28%, moderatein 57%, and severe in 15%. Activity was found in 29% of cases. Fibrosis was present in all cases: 26% mild, 62% moderate, and 12% severe. Autopsy cases did not show significant changes. A simple and reproducible scoring system of inflammation and fibrosis of the gallbladder is proposed. Three numbers refer to mild, moderate, or severe degrees of chronic inflammation and activity, with a final score that results from adding both values. The fibrosis is classified in three different stages. The final report uses both values to classify the chronic cholecystitis. A scoring system for chronic cholecystopathy to replace descriptive terms would give an exact transduction of the observed changes in an objective fashion that could not be misinterpreted by physicians or other pathologists.