title: Marked infiltration of eosinophils in necrotizing granulomas in the resected hepatic bed after cholecystectomy resulting from gallbladder cancer and metastatic liver cancer is associated with peculiar peripheral eosinophilia.
abstract: It is known that after transurethral resection of the prostate (TUR-P) or a bladder tumor (TUR-BT), necrotizing granuloma formation associated with massive eosinophil accumulation can be detected at the site of the scar, revealing marked eosinophilia. This condition is called post-TUR prostatitis or cystitis. In the present study, we noticed a similar phenomenon in five patients who underwent cholecystectomy, of whom four had gallbladder adenocarcinoma and one had metastatic liver cancer originating from the rectum. We detected necrotizing granulomas with massive eosinophil accumulation, associated with marked eosinophilia. To induce these phenomena, the interval between the first operation (i.e., cholecystectomy) and the second operation (i.e., resection of the hepatic bed and extrahepatic bile duct) is very important. If the interval was 1 week, no granuloma formation was detected. On the other hand, if it was more than 2 weeks, the resected hepatic bed contained necrotizing granulomas with substantial eosinophil accumulation combined with an increase in peripheral eosinophilia (up to 34% in one case). Secondary resection was necessary to induce eosinophilia after cholecystectomy. In this sense, malignancies possessed a relationship with delayed eosinophilia. In the granulomas, some foreign body-type multinucleated giant cells were positive for both anti-interleukin (IL)-5 and CD68 antibodies. In sharp contrast, no eosinophilia was detected after cholecystectomy, with or without hepatic resection consequent to severe adhesion. Clinicians as well as pathologists should keep in mind that these peculiar phenomena of eosinophil accumulation surrounding the necrotizing granulomas and peripheral eosinophilia after cholecystectomy could occur.
authors.affiliation: Division of Pathology, Matsuyama-Shimin Hospital, Matsuyama, Ehime, 790-0067, Japan. y.ohtsuki@matsuyama-shimin-hsp.or.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ohtsuki
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Ryohei
authors.initials: R
authors.lastname: Watanabe
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Okada
authors.forename: Yuki
authors.initials: Y
authors.lastname: Teratani
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kurabayashi
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Gang-Hong
authors.initials: GH
authors.lastname: Lee
authors.forename: Mutsuo
authors.initials: M
authors.lastname: Furihata
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002763:Cholecystectomy / Q000009:adverse effects*; D004802:Eosinophilia / Q000276:immunology; D004804:Eosinophils / Q000276:immunology*; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery*; D006099:Granuloma / Q000276:immunology* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology