Gallbladder dysplasia can progress to cancer and may be associated with increased cancer risk at other biliary tract sites. Thus, its accurate identification is relevant both for etiologic understanding and for clinical purposes. Data on the frequency and distribution of gallbladder dysplasia are lacking owing to limited gallbladder sampling and inability to visualize dysplasia grossly. An expert pathology group used consensus criteria to review 140 totally sampled consecutive cholecystectomy specimens from Chilean women. Three cases (2%) revealed incidental invasive carcinoma, all T2, along with high-grade dysplasia (HGD). The surface areas covered by dysplasia or cancer in these cases were 9%, 37%, and 87%. Although the first longitudinal ("diagnostic") section of the whole gallbladder captured HGD or cancer in all 3 cases, the deepest focus of invasive carcinoma was not present in this section. Fourteen additional cases (10%) had low-grade dysplasia (LGD), which was typically very focal (covering <5% of the surface) and most often occurred in the fundus. LGD was not present in the diagnostic section of 5 cases (38%) and would have been missed without additional sampling. None of the cancers or dysplasias were grossly visible. Although HGD and carcinoma are likely to be identified in "diagnostic" sections, accurate staging requires total sampling. LGD is typically very focal and would often be missed in routine practice. To identify cancer precursors, additional sampling, particularly of the fundus, may be warranted. The predominance of LGD in the fundus also provides etiologic insight, supporting the contribution of gallstones and chronic inflammation.

Mastitis, granulomatous mastitis, idiopathic granulomatous mastitis, bacteria, etiology

“Eosinophilic cholecystitis” has been an elusive concept. Around 1050 consecutive cholecystectomies with chronic (CC, n = 895), subacute (SAC, n = 100), and acute cholecystitis (AC, n = 55) were reviewed for eosinophilic infiltration. Eosinophilic hot spots (>40 eosinophils/HPF) were seen in 63% of SAC and 35% of AC (vs. 6% of CC, p < 0.001). Eosinophils were mostly encountered in areas of wall thickening, revealing edema with early collagenization and young tissue-culture-type fibroblasts. However, in ten chronic cholecystitis patients (100 eosinophils/HPF) was noted. These ten cases, classified as “eosinophilic cholecystitis”, were analyzed further: The patients were relatively young (mean age = 43 years), with a 9:1 female:male ratio. None had blood eosinophilia/eosinophilia syndromes. Although one had ulcerative colitis, others did not have any autoimmune diseases. The mean gallbladder wall thickness was 3.5 mm (vs. 4.2 mm in ordinary CC). In conclusion, eosinophils are a part of especially subacute injuries in the gallbladder. They are typically condensed in the areas of healing and appear to signify a distinctive state of injury in which there are erosions leading to slow/sustained exposure of the mural tissues to the bile contents that induce chemical injury/recruit eosinophils. Eosinophilic cholecystitis is a very uncommon occurrence and appears to be an exaggerated response in allergic patients who are prone to recruit eosinophils in reaction to injury.

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Hyalinising cholecystitis is a rare subtype of chronic cholecystitis. The characteristic feature of hyalinising cholecystitis is the presence of acellular or paucicular dens hyalinized fibrosis in the gallbladder wall. Calcification may occur in some cases. If calcification is common, porcelain gallbladder diagnosis is given. Porcelain gallbladder is closely associated with gallbladder carcinoma. Therefore, gallbladder carcinoma should be kept in mind in the differential diagnosis of hyalinized cholecystitis. Hyalinize kolesistit; kronik kolesistitin nadir bir alt tipidir. Safra kesesi duvarında asellüler ya da seyrek hücre içeren dens hyalinize fibrozis varlığı karakteristik özelliğidir. Bazı vakalarda fibrozise ek olarak safra kesesi duvarında kalsifikasyon görülebilir. Kalsifikasyon yaygın olursa porselen kese tanısı almaktadır. Porselen kese, safra kesesi karsinomu ile yakın ilişkilidir. Bu nedenle hyalinize kolesistit tanısı verirken ayırıcı tanıda safra kesesi karsinomunu mutlaka akılda tutmak gereklidir.