Piening Nicholas, Zussman Rachel, Markewycz Hanna, Piening Cole, Rossi Thomas
University of Illinois College of Medicine - Peoria, Department of Surgery, Peoria, IL, United States of America.
University of Illinois College of Medicine - Peoria, Department of Surgery, Peoria, IL, United States of America.
Int J Surg Case Rep. 2022 Sep;98:107571. doi: 10.1016/j.ijscr.2022.107571. Epub 2022 Sep 1.
Follicular cholecystitis (FC) is a rare entity found, it is found in 0.1-1 % of patients with chronic cholecystitis. 1,2 This pathologic finding has been associated with extrahepatic biliary obstruction distal to the gallbladder, such as primary sclerosing cholangitis, choledocholithiasis, and distal biliary strictures.
Our patient is a 32-year-old female with a past medical history significant for obesity presented with symptoms of postprandial nausea and spasmodic abdominal pain. An abdominal ultrasound was performed with findings adenomyosis and possible gallbladder polyps or adherent stones. The patient was referred to surgery and a routine laparoscopic cholecystectomy with liver biopsy was performed. On pathology, the gallbladder was found to have chronic, active follicular cholecystitis with cholelithiasis. Percutaneous needle liver biopsy revealed the following: focal, mild periductal fibrosis, mild portal fibrosis with minimal mixed micro- and macrovesicular steatosis, and no significant steatohepatitis.
To the best of our knowledge, this is the first documented case of follicular cholecystitis with associated hepatic findings on pathology. Follicular cholecystitis is strongly associated with extrahepatic biliary obstruction distal to the gallbladder, but it has not been previously associated with liver fibrosis. We hope to bring awareness to this rare but significant pathology.
Our case is unusual due to the findings of hepatic periductal fibrosis with follicular cholecystitis. Follicular cholecystitis is strongly associated with extrahepatic biliary obstruction distal to the gallbladder but it has not been documented it to be associated with any hepatic findings or pathology.
滤泡性胆囊炎（FC）是一种罕见病症，在慢性胆囊炎患者中占0.1% - 1%。1,2 这一病理发现与胆囊远端的肝外胆管梗阻有关，如原发性硬化性胆管炎、胆总管结石和远端胆管狭窄。
我们的患者是一名32岁女性，有肥胖病史，出现餐后恶心和痉挛性腹痛症状。进行了腹部超声检查，发现有子宫腺肌病以及可能的胆囊息肉或粘连结石。患者被转诊至外科，进行了常规腹腔镜胆囊切除术并取肝活检。病理检查发现胆囊有慢性活动性滤泡性胆囊炎并伴有胆结石。经皮肝穿刺活检结果如下：局灶性轻度导管周围纤维化、轻度门脉纤维化，伴有少量混合性微泡和大泡性脂肪变性，无明显脂肪性肝炎。
据我们所知，这是首例病理检查发现滤泡性胆囊炎伴有肝脏相关表现的病例记录。滤泡性胆囊炎与胆囊远端的肝外胆管梗阻密切相关，但此前尚未发现其与肝纤维化有关。我们希望提高对这种罕见但重要的病理学的认识。
我们的病例因发现肝导管周围纤维化合并滤泡性胆囊炎而不同寻常。滤泡性胆囊炎与胆囊远端的肝外胆管梗阻密切相关，但此前尚无文献记载其与任何肝脏表现或病理相关。
