Eosinophilic and lymphoeosinophilic cholecystitis

Area of Science:

• Gastroenterology
• Pathology
• Surgical Pathology

Background:

• Eosinophilic cholecystitis (EC) is a rare, poorly understood gallbladder inflammation.
• EC is characterized by a predominant eosinophilic infiltrate in the gallbladder wall.
• Previous reports associate EC with acalculous cholecystitis, subacute presentations, and drug therapies.

Purpose of the Study:

• To investigate the prevalence and clinicopathologic features of EC.
• To determine associations between EC and clinical factors like symptom timing, drug therapy, and cholelithiasis.
• To clarify EC's relationship with acalculous cholecystitis.

Main Methods:

• Retrospective analysis of 217 consecutive cholecystectomy specimens.
• Histopathologic examination focusing on inflammatory cell infiltrate, particularly eosinophils.
• Correlation of pathological findings with clinical data including symptom duration, drug history, and presence of gallstones.

Main Results:

• Eosinophils were present to some degree in 22.2% of specimens.
• EC was diagnosed in 6.4% of specimens; another 6.4% showed substantial eosinophils with mixed inflammatory cells.
• EC was significantly more common in patients with acalculous cholecystitis (6/8 cases) compared to those with cholelithiasis.
• No association found between EC and symptom timing, drug therapy, or other medical conditions.

Conclusions:

• Eosinophilic cholecystitis is more prevalent than previously recognized.
• EC may represent a distinct subgroup of gallbladder inflammation, possibly a hypersensitivity response.
• EC is more common in acalculous cholecystitis, suggesting a specific inflammatory pathway in stone-free patients.