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A histopathological and histochemical study of cholecystitis
Ponniah Anupama1, Menon Nirmala V.2, Ramakrishnan Janaky3, llias Laila Mohammed1, Mohammed Babitha Alingal1, Nalakath Asiq Sideeque4
1MBBS, MD, Assistant Professor, Department of Pathology, MES Medical College, Perinthalmanna, Kerala, India.
2MBBS, MD, Professor, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
3MBBS, Junior Resident, Department of Pathology, MES Medical College, Perinthalmanna, Kerala, India
4MBBS, MD, Professor and Head of Department, Department of Pathology, MES Medical College, Perinthalmanna, Kerala, India.

Article ID: 100025IJHPDPA2014
doi:10.5348/ijhpd-2014-25-OA-13

Address correspondence to:
Dr. Ponniah Anupama
Department of Pathology, MES Medical College and Hospital
Malaparamba, Palachode P. O, Kolathur via
Perinthalmanna, Malapuram District
Kerala, India. Postal Code -679338
Phone: +919447973557

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How to cite this article
Anupama P, Menon Nirmala V, Janaky R, Mohammed IL, Alingal MB, Sideeque NA. A histopathological and histochemical study of cholecystitis. Int J Hepatobiliary Pancreat Dis 2014;4:70–80.


Abstract
Aims: The present study mainly aimed to assess the qualitative and quantitative assessment of gallbladder mucins in chronic calculous cholecystitis, correlating the mucin histochemistry and morphology of the gallbladder in chronic calculus cholecystitis with each other and with chemical composition of gallstones.
Methods: Hematoxylin and Eosin stained sections of the selected specimens were screened and one to two sections with adequate amount of well-preserved mucosa with lining epithelium were chosen. The corresponding paraffin blocks were selected and isolated. Four sections were cut on each of the selected blocks for special stains.
Results: Comparison of inflammation and mucin histochemistry, inflammation and metaplasia, composition of calculi and grade of inflammation, composition of stones and mucin histochemistry, composition of calculi and metaplasia, fibrosis and mucin histochemistry, fibrosis and stone composition indicated a decrease in intraepithelial total acid mucin content in chronic calculous cholecystitis. Cases with severe inflammation showed the maximum decrease in sulfomucin, concomitant increase in sialomucin scores and a high incidence of gastric metaplasia. Intestinal metaplasia on other hand did not correlate with the degree of inflammation or sialomucin content.
Conclusion: This study concludes that normally gallbladder epithelium contains sulfated acid mucins with traces of neutral and sialomucins. The sulfomucin content decreases in chronic calculous cholecystitis and with severe inflammation, total acid mucin content decreases, neutral mucin increases, and there is a higher incidence of gastric metaplasia and pigment stones and correlating with pigment stones. This tends to have an association with severe inflammation, higher degree of fibrosis, gastric metaplasia and presence of sialomucin.

Keywords: Chronic calculous cholecystitis, Gallbladder stones, Metaplasia, Mucin histochemistry

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Author Contributions:
Ponniah Anupama – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Menon Nirmala V. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Ramakrishnan Janaky – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
llias Laila Mohammed – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Mohammed Babitha Alingal – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Nalakath Asiq Sideeque – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2014 Ponniah Anupama et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Anupama Ponniah is Assistant professor at department of pathology, MES medical college,KUHS University, Perinthalmanna, Kerala, India. She earned undergraduate degree (MBBS) from Sri Sidhartha Medical College, Bangalore University, Tumkur, India. and postgraduate degree (MD Pathology) from Department of pathology, PSG Institute of Medical Sciences and Research Centre, Coimbatore, India. She has published one research paper and two papers accepted and awaiting for publication in National journal. Her research interests include thyroid lesions, gastric lymphomas, breast cancer. She intends to pursue PhD in future.



Nirmala V. Menon is Emeritus Professor. She earned undergraduate degree (MBBS) from Trivandrum Medical College, Kerala and postgraduate degree (MD) in Pathology form Christian medical College, Department of Pathology, Vellore, Tamil Nadu, India. She has over 100 publications in national and international journals. Her research interests include gastrointestinal and liver pathology.



Janaky Ramakrishnan is Junior Resident/Tutor pursuing postgraduation in Pathology in Department of Pathology, MES Medical College, KUHS University, Perinthalmanna, Kerala, India. She earned undergraduate degree (MBBS) from Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham, India and is presently pursuing Masters degree (MD) in Pathology in Department of Pathology, MES Medical College, KUHS University, Perinthalmanna, Kerala, India. Her research interests include immunohistochemistry and breast pathology. She intends to pursue Oncopathology in future.



llias Laila Mohammed is Assistant Professor,Department of Pathology, MES Medical College, KUHS University, Perinthalmanna, Kerala, India. She earned undergraduate degree (MBBS) from M.S. RAMIAH Medical College, Bangalore University, Karnataka, India and postgraduate degree (MD) from Department of Pathology, Kasturba Medical College, Mangalore, India. She has an original article awaiting publication and two case reports published in a National journal. Her research interests include cardiac conduction system and thyroid lesions. She intends to pursue PhD in future.



Babitha A. M. is Assistant professor at Department of Pathology, MES Medical college, Perintalmanna, India. She has earned MBBS degree from Academy of Medical Sciences, Pariyaram, Kannur, India and postgraduate degree MD (pathology) from Government Medical College, Kottayam, India. She also earned Diplomate of national board degree in Pathology from Natboard , India. She intends to pursue PhD and FRCP in future. Her research areas include bone and renal lesions.



Asiq Nalakath Sideeque is Professor and Head of Department, Department of Pathology, MES Medical College, KUHS University, Perinthalmanna, Kerala, India. He earned undergraduate degree (MBBS) from Kempegowda Institute of Medical Sciences, Bangalore University, Karnataka, India and postgraduate degree form (MD Pathology) from Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, India. He has published papers in National and International journals. His research interests include genetics (Stem cell transplantation)