Hyalinizing cholecystitis presenting as acute calculous cholecystitis: diagnostic challenges and a review of the literature
Abdulaziz Alrubaiaan, Farah Altunaib, Saqer Alenezi, Yahia Chaar, Sulaiman Alrushaidan, Ali Alabdulsalam, Abdullatif AljadiAbstract
Introduction
Hyalinizing cholecystitis is a rare histopathological variant of cholecystitis, characterized by dense hyaline fibrosis in the gallbladder wall. It is seldom suspected preoperatively because its clinical and radiological features often overlap with acute calculous cholecystitis. Recognition is important because of its reported association with gallbladder carcinoma, requiring careful pathological examination of the cholecystectomy specimen.
Case Description
We report the case of a 34-year-old man with diabetes mellitus, hypertension, and paraplegia, who presented with a one-week history of right upper quadrant pain, fever, and fatigue. Laboratory test findings revealed leukocytosis and markedly elevated inflammatory marker levels. Ultrasonography showed a distended gallbladder with multiple calculi and sludge and mild biliary dilatation. Magnetic resonance cholangiopancreatography excluded biliary obstruction. The patient underwent a laparoscopic cholecystectomy, which revealed diffuse inflammation with whitish patches on the gallbladder wall. Histopathological examination confirmed hyalinizing cholecystitis with cholelithiasis, without evidence of malignancy.
Discussion
A literature review was undertaken to summarize the clinical presentation, pathological findings, and management of previously reported cases. This case highlights the diagnostic challenges of hyalinizing cholecystitis and emphasizes the importance of histopathological examination for definitive diagnosis because of the reported association between hyalinizing cholecystitis and gallbladder carcinoma.