title: Cholesterolosis in routine histopathological examination after cholecystectomy: what should a surgeon behold in the reports?
abstract: BACKGROUND
  Cholecystectomy is one of the most common surgical procedures. Postoperative investigation of cholecystectomy specimen has a great value since histopathological reports may document some entities with significant clinical consequences. The aim of this study was to evaluate the association between cholesterolosis and the reports indicating some histopathological alterations in symptomatic cholecystitis.
  
  
  METHODS
  This paper is based on a retrospective study. Histopathological reports of 432 cholecystectomy specimens between January 2011 and June 2013 were reviewed. Three reports were excluded due to perioperative diagnosis of cancer. Reports of 429 cholecystectomy specimens of the acute and symptomatic chronic cholecystitis patients were analyzed. Standardization of the reporting was questioned. Age, gender, histopathological wall thickness of gallbladder, reporting rates of acute inflammation, cholesterolosis, polypoid lesions, epithelial hyperplasia, gastric or intestinal metaplasia, dysplasia and incidental cancer were investigated and compared between patients with and without cholesterolosis. Reported rates of histopathological findings were comparable between patients under and over 60 years old and patients with and without reported cholesterolosis.
  
  
  RESULTS
  Reported histopathological findings were presented as acute inflammation in 46 (10.7%), cholesterolosis in 79 (18.4%), gallbladder polypoid lesions in 7 (1.6%), epithelial hyperplasia in 16 (3.7%), metaplasia of any type in 34 (7.9%) of 429 patients. Dysplasia was excluded whereas one incidental gallbladder carcinoma was reported. Epithelial hyperplasia and metaplasia were found to be related to age. Gallbladder wall thickness was decreased with cholesterolosis. However, only a correlation between cholesterolosis and gender or metaplasia was noted.
  
  
  CONCLUSIONS
  Recent study suggests that cholesterolosis is somehow associated with metaplasia. Thus, surgeons should carefully interpret the histopathology reports based on unusual or exceptional findings corresponding to the cholecystectomy specimens. Any abnormal finding in the reports should be investigated in terms of the progress of the pathology and also its clinical consequences.
authors.affiliation: Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: faikyaylak@lycos.com.
authors.forename: Faik
authors.initials: F
authors.lastname: Yaylak
authors.affiliation: Department of Pathology, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: ayhade@yahoo.com.
authors.forename: Aysenur
authors.initials: A
authors.lastname: Deger
authors.affiliation: Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: bercis.imge@gmail.com.
authors.forename: Bercis Imge
authors.initials: BI
authors.lastname: Ucar
authors.affiliation: Department of General Surgery, Evliya Celebi Research and Education Hospital, 43020 Kutahya, Turkey. Electronic address: dryalcinsonmez@gmail.com.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Sonmez
authors.affiliation: Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: zulfubayhan@gmail.com.
authors.forename: Zulfu
authors.initials: Z
authors.lastname: Bayhan
authors.affiliation: Department of General Surgery, Ankara Ataturk Education and Research Hospital, Ankara, Turkey. Electronic address: drfahriyetisir@hotmail.com.
authors.forename: Fahri
authors.initials: F
authors.lastname: Yetisir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D002764:Cholecystitis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D002784:Cholesterol / Q000378:metabolism*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008499:Medical Records; D008679:Metaplasia; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D002784:Cholesterol
keywords: Age; Carcinoma; Cholecystectomy; Cholesterolosis; Gallbladder; Inflammation; Metaplasia; Morphology