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Case Reports
. 2019 Mar 15;58(6):803-807.
doi: 10.2169/internalmedicine.1805-18. Epub 2018 Nov 19.

An Unusual Case of Acute Cholecystitis with Amyloidosis: A Case Report and Literature Review

Shogo Matsuda  1 , Makoto Nishikata  2 , Koji Takai  2 , Takayuki Motoyoshi  2 , Yasuhide Yamashita  2 , Toshihiko Kirishima  2 , Naomi Yoshinami  2 , Hiroyuki Shintani  2
Affiliations
Case Reports

An Unusual Case of Acute Cholecystitis with Amyloidosis: A Case Report and Literature Review

Shogo Matsuda et al. Intern Med. .

Abstract

We present an extremely rare case of amyloid A (AA) deposition in the gallbladder and review the literature on similar cases. The patient was a 76-year-old man who had been diagnosed with mild bronchiectasis three years previously, who was admitted to the hospital with right upper quadrant pain and fever. Computed tomography revealed swelling and wall thickening of the gallbladder with a small gallstone. The patient was diagnosed with acute cholecystitis and cholelithiasis and underwent open cholecystectomy. A postoperative histological examination revealed extensive AA deposition in the gallbladder wall. Thus, the definitive diagnosis was acute cholecystitis with AA amyloidosis.

Keywords: acute cholecystitis; amyloid A; amyloidosis.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
(A) Computed tomography reveals swelling and wall thickening of the gallbladder and a small gallstone (arrow) with no visible mass in the gallbladder. (B) Enhanced computed tomography reveals peripheral gallbladder effusion without necrosis of the gallbladder wall or a malignant lesion.
Figure 2.
Figure 2.
Macroscopic findings of the resected gallbladder. (A) In the opening along the long axis, multiple erosions and submucosal hemorrhages are observed in the body of the gallbladder. (B) On longitudinal sectioning, a markedly thickened gallbladder wall is observed in the body of the gallbladder.
Figure 3.
Figure 3.
(A) Postoperative Hematoxylin and Eosin staining reveals infiltration of neutrophils, monocytes, and eosinophils in the mucosal lamina propria and eosinophilic amorphous deposition in the mucosal lamina propria and the muscle layers (magnification, 20×). (B) Salmon pink-colored eosinophilic deposition (Dylon staining; magnification, 40×). (C) The deposition exhibits apple-green birefringence under polarized light (magnification, 200×).
Figure 4.
Figure 4.
Computed tomography scan showing mild bronchiectasis (arrow) in the middle lobe of the right lung.
See this image and copyright information in PMC

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