Ceroid granulomas of the gallbladder. A clinicopathologic study of nine cases

Nine cases of ceroid granulomas of the gallbladder were found in 125 surgically excised gallbladders during a one year review (7.35%), corresponding to an estimated incidence of 2.1 cases per 100,000 inhabitants per annum. Seven patients were under 50 year of age. Four patients presented symptoms and signs of chronic cholecystitis. However, in five cases, a mass in the right hypochondrium was palpated, mimicking a carcinoma of the gallbladder. The lesion was characterized by intramural or mucosal yellow-brown nodules composed of ceroid-laden histiocytes. The presence of intramural destructive necrosis in one case suggests that ceroid granulomas of the gallbladder have the potential of developing fistulae or perforations. Rupture of the Rokitansky-Aschoff sinuses and mucosal ulceration with intramural liberation of bile were implicated in the pathogenesis. The characteristic microscopic appearance, as well as the ceroid nature of the granules revealed by histochemical and ultrastructural studies, support the view that ceroid granulomas of the gallbladder should be recognized as a distinct histo-pathological entity. It is important to recognize this lesion as it can be mistaken for carcinoma and may be responsible for serious complications, such as fistulae or perforation.