Chronic cholecystitis with follicular lymphoid hyperplasia: nomenclature and diagnostic dilemmas

Abstract

Background: To revisit the nomenclature, prevalence, histogenesis and the diagnostic dilemmas in cases of cholecystitis with lymphoid hyperplasia received in a private laboratory in one-year duration.Methods: A total of 51 cases of cholecystectomy were examined histopathologically to identify and review all the cases with emphasis on cholecystitis with marked lymphoid infiltration.Results: Out of 51 cholecystectomy specimens, some rare entities were observed such as 4 cases (8%) of xanthomatous change, 2 cases (4%) of cholecystitis with follicular lymphoid hyperplasia and a case of hyalinizing cholecystitis.Conclusions: The literature on cholecystitis with marked lymphoid infiltrate (with or without follicle formation) was overlapping and thus confusing. The same has been simplified with review of literature.

Follicular Cholecystitis Mimicking Xanthogranulomatous Cholecystitis and Malignancy: A Case Report

“…7,8 For the diagnosis, an increase in the number of intraepithelial lymphocytes per 100 biliary cells above the normal proportion of three to four lymphocytes is needed. 9 The pathogenesis of CFC is unclear although it may be caused by an immune reaction to luminal agents of the gallbladder. 10 Other theories include an autoimmune-mediated disorder in other areas of the gastrointestinal tract or gram-negative bacterial infection that induce a lymphocytic reaction, such as E. coli, K. pneumoniae, or S. typhi.…”

“…10 Other theories include an autoimmune-mediated disorder in other areas of the gastrointestinal tract or gram-negative bacterial infection that induce a lymphocytic reaction, such as E. coli, K. pneumoniae, or S. typhi. [9][10][11] This inflammatory pattern can be encountered in other parts of the gastrointestinal tract such as the esophagus, stomach, duodenum and colon, and in the orbits and lungs. 8 Risk factors for developing CFC are unclear because there are uncertain causal associations.…”

“…7 8 For the diagnosis, an increase in the number of intraepithelial lymphocytes per 100 biliary cells above the normal proportion of three to four lymphocytes is needed. 9 …”

Follicular cholecystitis with cholelithiasis – A diagnostic pitfall

“…On reviewing Indian literature on FC, we observed that, there are very few case reports of FC. [2][3][4]8 Mohan et al 9 studied 1100 cholecytectomies in North india and reported a high incidence of 2.3% with 26 cases of FC. Mahajan et al 6 studied 656 cases of cholecystectomies and reported relatively low incidence of 0.61% (4 cases).…”

Untitled

“…Historically, Escherichia coli, Klebsiella pneumoniae, and Salmonella typhi infections caused by gram-negative bacteria have been linked to follicular cholecystitis [5,6]. In addition, many chronic cholecystitis patients exhibit pyloric metaplasia and detectable Helicobacter pylori infection of the gallbladder mucosa, albeit this does not seem to predict the particular histologic subtype [7,8].…”