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Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis

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Gallbladder amyloidosis is often unexpected and may have systemic implications.

Catherine E Hagen¹, Surendra Dasari², Jason D Theis¹

¹Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.

American Journal of Clinical Pathology

|August 29, 2025

Summary

Gallbladder amyloidosis is often an unexpected diagnosis, with the gallbladder frequently being the first tissue identified with the disease. All patients studied showed systemic involvement, highlighting the need for early detection and management.

Keywords:

amyloidosis cardiac involvement cholecystectomy gallbladder proteomics systemic amyloidosis

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Area of Science:

Pathology
Medical Diagnostics
Proteomics

Background:

Amyloidosis is a systemic disease characterized by extracellular deposition of misfolded proteins.
Gallbladder involvement in amyloidosis is not widely recognized, potentially leading to diagnostic delays.

Purpose of the Study:

To analyze a large cohort of gallbladder amyloidosis cases.
To identify the clinical and morphologic features of gallbladder amyloidosis.
To determine the types and prevalence of amyloid in the gallbladder.

Main Methods:

Retrospective review of 118 cholecystectomy specimens analyzed between 2008 and 2023.
Proteomics-based techniques were used for amyloid typing.
Clinical and morphologic features were assessed.

Main Results:

Six types of amyloid were identified, with transthyretin amyloidosis (ATTR) and light-chain amyloidosis (AL) being the most common.
Amyloidosis was an unexpected diagnosis in half of the patients with clinical information.
Perimuscular vessel involvement was observed in all morphologically reviewed cases.
All patients with follow-up demonstrated evidence of systemic disease.

Conclusions:

Gallbladder amyloidosis is frequently an unexpected finding and may be the initial presentation of systemic disease.
Careful examination of cholecystectomy specimens, particularly perimuscular vessels, is crucial.
Prompt amyloid typing, especially in elderly patients, can prevent diagnostic delays and improve management.