Saka Burcu, Memis Bahar, Seven Ipek Erbarut, Pehlivanoglu Burcin, Balci Serdar, Bagci Pelin, Reid Michelle, Dursun Nevra, Escalano Oscar Tapia, Roa Juan Carlos, Araya Juan Carlos, Kong So Yeon, Basturk Olca, Koshiol Jill, Adsay N Volkan
218502Istanbul Medipol University, Istanbul, Turkey.
1371Emory University, Atlanta, GA, USA.
Int J Surg Pathol. 2020 Dec;28(8):826-834. doi: 10.1177/1066896920924079. Epub 2020 May 18.
CONTEXT.: Follicular cholecystitis (FC) is a poorly characterized entity.
OBJECTIVE.: To determine its frequency/clinicopathologic associations.
DESIGN.: A total of 2550 cholecystectomy specimens were examined. Two hundred three of these were consecutive routine cholecystectomies submitted entirely for microscopic examination to determine the relative frequency of incidental pathologies in gallbladders (GBs). The remainder had representative sampling. Underlying conditions were nonobstructive pathologies (1270 nonspecific cholecystitis), obstructive (62 distal biliary tract tumors, 35 primary sclerosing cholangitis, and 31 autoimmune pancreatitis), and neoplastic (n = 949). FC was defined as 3 distinct lymphoid follicles (LFs)/centimeter.
RESULTS.: In the GBs totally submitted for microscopic examination, the true frequency of FC was found to be 2.5% (5/203), and in the representatively sampled group, it was 1.9%, with similar frequencies in nonobstructive, obstructive, and neoplastic cases (2.3%, 3.1%, and 1.3%, respectively, = .77). When the 39 FC in nonneoplastic GBs contrasted with ordinary chronic cholecystitis, they were associated with older age (68 vs 49 years, < .0001), similar gallstone frequency (68 vs 81%), female/male ratio (2.7 vs 2.6), and wall thickness (4 mm for both). None had lymphoma/parasites/ infection. Of 17 cases who had undergone gastric biopsy, 5 had chronic gastritis (2 with ). Microscopically, the LFs were the main inflammatory process often with minimal intervening inflammation. IgG4-positive plasma cell density was low (<10/high-power field) in 21/24(87.5%) cases.
CONCLUSIONS.: Follicular cholecystitis is seen in 2% of cholecystectomies, typically in significantly older patients, suggesting a deranged immune response. A third of the patients reveal biopsy-proven gastritis. FC does not seem to be associated with autoimmunity, lymphoma, or obstructive pathologies.
滤泡性胆囊炎（FC）是一种特征描述不充分的疾病。
确定其发病率及临床病理相关性。
共检查了2550份胆囊切除术标本。其中203份是连续的常规胆囊切除术标本，全部送显微镜检查以确定胆囊（GB）中偶然病变的相对发病率。其余标本进行代表性抽样。基础疾病包括非梗阻性病变（1270例非特异性胆囊炎）、梗阻性病变（62例远端胆道肿瘤、35例原发性硬化性胆管炎和31例自身免疫性胰腺炎）和肿瘤性病变（n = 949）。FC定义为每厘米有3个不同的淋巴滤泡（LFs）。
在全部送显微镜检查的胆囊中，FC的实际发病率为2.5%（5/203），在代表性抽样组中为1.9%，在非梗阻性、梗阻性和肿瘤性病例中的发病率相似（分别为2.3%、3.1%和1.3%，P = 0.77）。当将非肿瘤性胆囊中的39例FC与普通慢性胆囊炎对比时，发现FC与年龄较大有关（68岁对49岁，P < 0.0001），胆结石发病率相似（68%对81%），女性/男性比例相似（2.7对2.6），胆囊壁厚度相同（均为4 mm）。均无淋巴瘤/寄生虫/感染。在17例接受胃活检的病例中，5例有慢性胃炎（其中2例有幽门螺杆菌感染）。显微镜下，淋巴滤泡是主要的炎症过程，其间炎症通常很轻微。24例中有21例（87.5%）IgG4阳性浆细胞密度较低（<10/高倍视野）。
FC在2%的胆囊切除术中可见，通常见于年龄明显较大的患者，提示免疫反应紊乱。三分之一的患者经活检证实有胃炎。FC似乎与自身免疫、淋巴瘤或梗阻性病变无关。
