Chronic Cholecystitis : Metaplastic Changes

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Metaplastic Changes in Chronic Cholecystitis: Chronic inflammation of the gallbladder mucosa may induce pyloric or antral metaplasia, gastric type mucinous or columnar metaplasia, intestinal metaplasia and even squamous metaplasia. The last two are quite rare. The most common is antral or pyloric metaplasia.

Antral metaplasia (shown in this image) consists of tubular glands in the lamina propria lined by columnar cells with clear cytoplasm and abundant mucin. Metaplastic pyloric glands may be present deep within the smooth muscle (when metaplasia involves Rokitansky-Aschoff sinuses) and show proliferative changes and even suggestion of perineural or intraneural invasion. This can lead to the mistaken diagnosis of adenocarcinoma. Bland cytologic features and lobular architecture of the glands favor benign diagnosis.