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Gallbladder Pathology Online

Pathology of Chronic Cholecystitis

Dr Sampurna Roy MD


Chronic cholecystitis is rarely seen in the absence of lithiasis.

The associated stones are of the mixed or combined type.

The female to male ratio is 3 to 1 with the peak incidence in the 5th and 6th decades.

The gall bladder may be shrunken and fibrotic or distended depending on its level of obstruction and the duration of disease.

Rokitansky-Aschoff sinuses are usually present with or without inspissated bile.

Bile granulomas may be seen in relation to Rokitansky-Aschoff sinuses.

There is variable fibrosis throughout the wall. The chronic inflammation is variable.

There may be changes of previous acute cholecystitis.


Microscopic image of chronic cholecystitis showing thick mucosa, absence of normal folds and a dense chronic inflammatory infiltrate. The muscle coat is hypertrophied and there are relatively few inflammatory cells.

Ulcer associated cell lineage may be seen in association with intestinal metaplasia and argentaffin cells.

Chronic follicular cholecystitis occasionally occurs where prominent lymphoid follicles are seen throughout the wall. This is more common in patients with typhoid fever. These need to be differentiated from gallbladder involvement by malignant lymphoma. Lymphoma of Gallbladder

Localized tissue reactions with cholesterol crystals may be seen within the thickened fibrous wall underlying an ulcer.

Malakoplakia is another morphologic form of chronic cholecystitis, with formation of Michaelis-Gutmann bodies.


Further reading:

Chronic cholecystitis with lymphoid hyperplasia

H pylori are associated with chronic cholecystitis.

H pylori exist in the gallbladder mucosa of patients with chronic cholecystitis  

Hyperplasia, metaplasia, dysplasia and neoplasia lesions in chronic cholecystitis - a morphologic study 

Study on carcinogenesis in chronic cholecystitis.

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

Diffuse lymphoplasmacytic chronic cholecystitis is highly specific for extrahepatic for extrahepatic biliary tract disease but does not distinguish between primary and secondary sclerosing cholangiopathy.   

Lymphoplasmacytic chronic cholecystitis and biliary tract disease in patients with lymphoplasmacytic sclerosing pancreatitis  

Study on carcinogenesis in chronic cholecystitis.













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