Patterns and Significance of Eosinophils in Gallbladder Injury: An Analysis of 1050 Cholecystectomies.
Burcu Saka, Nevra Dursun, Olca Basturk, Juan Carlos Roa, Oscar Tapia, Sudeshna Bandyopadhyay, Leslie Ducato, Pelin Bagci, NVolkan Adsay. Emory, GA; MSKCC, NY; UFRO, Temuco, Chile; WSU, MI
Background: There is minimal data in the literature regarding the role of eosinophils (EOS) in gallbladder (GB) injury. The term “eosinophilic cholecystitis” has been used variably with the reported incidence ranging from 0.5-6.4 %.
Design: 1050 GB resections composed of 895 chronic cholecystitis (CC), 100 subacute cholecystitis (SC) and 55 acute cholecystitis (AC) were reviewed, and > 40 EOS/HPF was regarded as eosinophilia. Those with numerous foci of eosinophilia in the background of diffuse but lesser amount of EOS were classified as CC with prominent eosinophilia, and those that had diffuse and massive eosinophilia throughout the GB, as eosinophilic CC.
Results: I. Eosinophilia was significantly more common in SC (63%) than in AC (35%) and in CC (6%; p=0.000). II. In SC, EOS were concentrated in the areas of denuded epithelium, where stones were dislodged, and where the signs of subacute disease such as tissue culture fibroblasts were more prominent. Similarly, in AC, they were mostly in the areas of ulceration. III. Among CC cases, 6 qualified as CC with prominent eosinophilia, and these were relatively young (mean age=45 vs 49 in ordinary cholecystitis) females (F/M=5 vs 3.1), 4/6 with history of allergies (including one with asthma) and with relatively uninjured gallbladders with a wall thickness of 3.4 mm (vs 5.2 mm). All were associated with stones. IV. Four cases had massive EOS, classified as eosinophilic CC, and these were even younger patients (mean age=41 vs 49 in ordinary cholecystitis); all females; 2/4 with history of allergies, and one with ulcerative colitis. None of the CC with prominent eosinophilia or eosinophilic CC cases had blood eosinophilia, gastroenteritis, history of parasites, or eosinophilia-myalgia syndrome.
Conclusions: There are 2 distinct mechanisms with which eosinophils participate in GB injury. One, in the setting of acute and subacute disease associated with breached epithelial integrity leading to exposure of GB wall to the chemical effects of the bile and chemotaxis of eosinophils. Second, in the setting of chronic cholecystitis with relatively uninjured gallbladders, and occurs in younger females with associated allergic conditions. True eosinophilic cholecystitis (with diffuse and massive eosinophilia) is a very uncommon condition (0.4% of cholecystectomies) that may have allergic basis.
Category: Liver & Pancreas
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 195, Wednesday Morning