Validity of Diagnostic Criteria of Chronic Cholecystitis

The clinical diagnosis of chronic cholecystitis (CCH) is generally verified by biopsy. It involves numerous and variable morphological findings, ranging from minimal to gross alterations in the gallbladder structure. Many surgeons have misused the term cholecystitis as a synonym for cholecystolithiasis. The controversial category of “minimal CCH” includes the presence of slight mononuclear infiltration of the gallbladder mucous membrane, regardless of whether lithiasis is present or not. We examined histological findings in gallbladder mucous membranes from autopsy materials of 10 persons unaffected by hepatobiliary disease. Histological findings from five subjects, in whom post mortem changes were absent, revealed “minimal CCH“, which is easy to misdiagnose and confuse with the appearance of a normal immunological barrier. In a series of 20 gallbladders harvested from the explanted livers of transplanted patients with unaffected extrahepatal biliary tracts, “minimal CCH“ was observed in all cases. We conclude that the diagnosis of CCH based on the presence of “minimal changes“ is not valid and cannot support the indication for cholecystectomy, if this is evaluated ex post. We revised biopsy specimens evaluated as CCH by various pathologists. Out of 100 bioptic samples analysed and classified on the basis of a scheme designed by us, “minimal CCH“ findings were present in the “atrophic cholecystitis“ and “miscellaneous“ categories. We assessed the validity of CCH diagnosis by analysing the biopsy records of 100 patients with cholecystectomy, in whom the diagnosis was based on both clinical and morphological findings. Most of the records (63) had the term “chronic cholecystitis“ as a concluding diagnosis and, only in 37 records, more or less detailed descriptions of pathological alterations in gallbladder walls were provided. It is concluded that further studies are needed to elucidate the pathological basis of “minimal CCH“ and its relation to the natural immunological barrier protecting the mucous membrane of the gallbladder. K e y w o r d s gallbladder, mucous membrane, chronic cholecystitis, minimal chronic cholecystitis, immunological barrier