Cholecystitis and Cholelithiasis Associated with an Intramural Fasciitis-Like Proliferation and Osseous Metaplasia

Abstract

Fasciitis-like proliferations are said to be uncommon in the viscera; a fasciitis-like pattern of gallbladder injury may not be rare, but to our knowledge it has not been explicitly reported as such in any age group. Osseous metaplasia, or heterotopic bone, in the gallbladder is rare and has not to our knowledge been reported in a pediatric patient. We report a 7-year-old boy with sickle cell disease who presented with right upper quadrant abdominal pain. An ultrasonograph demonstrated a dilated common bile duct with sludge and stones. A cholecystectomy was performed. Grossly the gallbladder showed numerous pigmented choleliths, and histologically there was cholecystitis with a fasciitis-like fibrous proliferation containing scattered osteoclast-like giant cells and an area of osseous metaplasia. This report, describing a pattern that could be termed "cholecystitis ossificans," expands the histologic spectrum of chronic cholecystitis, a common disease with a poorly understood pathogenesis.

Implications of radiologic-pathologic correlation for gallbladder disease in children and young adults with sickle cell disease

“…Within the literature, there is a case report of a 7-year-old boy with SCD who had cholelithiasis and pathology-proven Bcholecystitis ossificans,^which was characterized by fibrous proliferation and osseous metaplasia in the gallbladder wall [21]. We did not observe this entity in our study, but it may be within the spectrum of chronic cholecystitis according to the report.…”

Heterotopic Ossification in the Gallbladder

“…Since then, six cases have been reported in the English literature [2-8], of which four cases were associated with cholelithiasis and two cases showed spicules of bone in the cholesterol polyps [3,4]. Rege and Vargas [5] reported intramuscular fasciitislike proliferation and bony metaplasia in the gallbladder of a 7-year-old boy with sickle cell disease. They proposed the term cholecystitis ossificans to describe their case; furthermore, they suggested that the mucosal insult by repetition predisposed the gallbladder to dystrophic calcification and/or fasciitis, subsequently creating a favorable microenvironment for bone formation [5].…”

“…Rege and Vargas [5] reported intramuscular fasciitislike proliferation and bony metaplasia in the gallbladder of a 7-year-old boy with sickle cell disease. They proposed the term cholecystitis ossificans to describe their case; furthermore, they suggested that the mucosal insult by repetition predisposed the gallbladder to dystrophic calcification and/or fasciitis, subsequently creating a favorable microenvironment for bone formation [5]. This mechanism is further corroborated by reports of heterotopic ossification in other sites of chronic injury, such as atherosclerotic plaques, traumatic injury, and severe burns [1].…”

Osseous Metaplasia of the gallbladder: report of two cases

“…In the literature review, we determined seven reported cases so far. [3][4][5][6][7][8][9] Although Yosepovich et al described their case as the first one in the literature, there were two previous cases reported by Indyk et al and Ortiz-Hidalgo et al in 1957 and 2000, respectively. [3][4][5] Since then, four more cases had been reported.…”

“…[3][4][5] Since then, four more cases had been reported. [6][7][8][9] All the cases were adult patients except for the Rege et al's case who was a 7-year-old boy with sickle cell disease. [8] The metaplasia was associated with benign conditions like chronic cholecystitis, [5,8] a cholesterol polyp [4] and a fasciitis-like fibrous proliferation [8] in these cases.…”